Provider Demographics
NPI:1265784060
Name:JAMES, MINDY (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:MARI
Other - Middle Name:MARINDA
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:810 WOODLAND WAY
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-5718
Mailing Address - Country:US
Mailing Address - Phone:479-650-1250
Mailing Address - Fax:
Practice Address - Street 1:810 WOODLAND WAY
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-5718
Practice Address - Country:US
Practice Address - Phone:479-650-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist