Provider Demographics
NPI:1801879952
Name:HIGGINBOTHAM, GINA (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 DECLIFF LN
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-1383
Mailing Address - Country:US
Mailing Address - Phone:870-892-9593
Mailing Address - Fax:870-892-9593
Practice Address - Street 1:42 HELTER RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-1359
Practice Address - Country:US
Practice Address - Phone:870-248-1448
Practice Address - Fax:870-248-1450
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP1121235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X801OtherBCBS PROVIDER #
AR129521721Medicaid