Provider Demographics
NPI:1720039381
Name:WEBER, JAYNA ELIZABETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAYNA
Middle Name:ELIZABETH
Last Name:WEBER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2729 N WAKEFIELD PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4325
Mailing Address - Country:US
Mailing Address - Phone:479-841-7131
Mailing Address - Fax:
Practice Address - Street 1:1004 SE 5TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6032
Practice Address - Country:US
Practice Address - Phone:479-254-6717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2230235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist