Provider Demographics
NPI:1730224569
Name:MASHBURN, JEFF J (MS, CCC)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:J
Last Name:MASHBURN
Suffix:
Gender:M
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 HIGHWAY 65 N
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-6390
Mailing Address - Country:US
Mailing Address - Phone:501-745-2280
Mailing Address - Fax:501-745-7530
Practice Address - Street 1:230 HIGHWAY 65 N
Practice Address - Street 2:SUITE 9
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6390
Practice Address - Country:US
Practice Address - Phone:501-745-2280
Practice Address - Fax:501-745-7530
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK191231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist