Doctor Name: | MS. JENNIFER NICOLE JINES |
NPI Number: | 1154556389 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA CCC SLP |
License Number: | 2000159411 |
Business Practice Address: | 20794 Us Highway 61 Sikeston, MO - 638017260 |
Business Phone Number: | 5734712686 |
Business Fax Number: | 5734713515 |
Mailing Address: | 500 W Grant St Apt C, DEXTER |
State: | MO |
Postal Code: | 638412451 |
Phone Number: | 5734712686 |
Fax Number: | 5734713515 |
NPI Enumeration Date: | 05/18/2009 |
NPI Last Update Date: | 05/18/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 2000159411 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |