MEDICARE: LILLIAN HINES SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	S4592	MS

General Provider Information

NPI Number	:	1689296055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN HINES SLP

Provider Business Mailing Address
First Line	:	2500 N STATE ST
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4500
Country	:	US
Telephone Number	:	601-624-6292
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 LAKE CASTLE RD
Second Line	:
City	:	MADISON
State	:	MS
Zip	:	39110-8606
Country	:	US
Telephone Number	:	601-624-6292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2020
Last Update Date	:	09/04/2020

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Directions to “ LILLIAN HINES SLP” Practice Location

Language	Start Address	Practice Location

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