Provider Demographics
NPI:1700485117
Name:HINES, MICAH WINN
Entity type:Individual
Prefix:MRS
First Name:MICAH
Middle Name:WINN
Last Name:HINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 BARNSLEY CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6302
Mailing Address - Country:US
Mailing Address - Phone:513-312-8760
Mailing Address - Fax:
Practice Address - Street 1:9900 BARNSLEY CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-6302
Practice Address - Country:US
Practice Address - Phone:513-312-8760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist