Healthcare Provider Details

I. General information

NPI: 1316820483
Provider Name (Legal Business Name): SARAH GRACE BYRD HINKLE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH B HINKLE CCC-SLP

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 LAKELAND DR BLDG LP
JACKSON MS
39216-4651
US

IV. Provider business mailing address

PO BOX 11407, DEPT 2130
BIRMINGHAM AL
35246-2130
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-2005
  • Fax:
Mailing address:
  • Phone: 601-815-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS-5414
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: