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General NPI Number Information
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NPI Number | 1801879952
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Entity Type | Individual
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Provider Name | GINA HIGGINBOTHAM CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 42 HELTER RD
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City | POCAHONTAS
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State | AR
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Zip | 72455-1359
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Country | US
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Telephone | 870-248-1448
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Fax | 870-248-1450
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Provider Business Mailing Address
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Address Line | 328 DECLIFF LN
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City | POCAHONTAS
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State | AR
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Zip | 72455-1383
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Country | US
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Telephone | 870-892-9593
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Fax | 870-892-9593
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP1121
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License Number State | AR
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