Provider Demographics
NPI:1205350063
Name:HOLLINGSWORTH, KAINA MICKELL (SLP)
Entity type:Individual
Prefix:
First Name:KAINA
Middle Name:MICKELL
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:AR
Mailing Address - Zip Code:71652-0010
Mailing Address - Country:US
Mailing Address - Phone:870-952-0451
Mailing Address - Fax:
Practice Address - Street 1:22461 I 30 STE 1100A
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2379
Practice Address - Country:US
Practice Address - Phone:501-481-8930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist