Provider Demographics
NPI:1922752872
Name:BAGLEY, JENISE
Entity Type:Individual
Prefix:
First Name:JENISE
Middle Name:
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 HIGHWAY 365 STE 3
Mailing Address - Street 2:
Mailing Address - City:MAYFLOWER
Mailing Address - State:AR
Mailing Address - Zip Code:72106-9525
Mailing Address - Country:US
Mailing Address - Phone:501-470-5936
Mailing Address - Fax:501-470-3502
Practice Address - Street 1:582 HIGHWAY 365 STE 3
Practice Address - Street 2:
Practice Address - City:MAYFLOWER
Practice Address - State:AR
Practice Address - Zip Code:72106-9525
Practice Address - Country:US
Practice Address - Phone:501-470-5936
Practice Address - Fax:501-470-3502
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant