Provider Demographics
NPI:1750596912
Name:HUNTER, GENIAVE (MCD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GENIAVE
Middle Name:
Last Name:HUNTER
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:GENIAVE
Other - Middle Name:
Other - Last Name:HUSKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 40
Mailing Address - Street 2:152 EAST CASPER STREET
Mailing Address - City:LYNN
Mailing Address - State:AR
Mailing Address - Zip Code:72440
Mailing Address - Country:US
Mailing Address - Phone:870-528-3709
Mailing Address - Fax:
Practice Address - Street 1:295 MOCKINGBIRD ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-6615
Practice Address - Country:US
Practice Address - Phone:870-698-1529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150953721Medicaid