Gina C Mazzanti, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP 890 Issued in AR

Practice address

216 Main St
Lake Village, AR 71653-1916

Phone

(870) 265-6619

NPI assigned

Oct 12, 2007

Last updated

Oct 12, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Occupational Therapy Services Inc.

  dba KidSense Therapy Clinic

  • Pediatric Occupational Therapist
  • Lake Village, AR
  • NPI 1942314893

  Speech-Language Pathologist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192147200000",
    "number": "1568650760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 MAIN ST",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "716531916",
            "telephone_number": "870-265-6619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 MAIN ST",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "716531916",
            "telephone_number": "870-265-6619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZANTI",
        "first_name": "GINA",
        "middle_name": "C",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-12",
        "last_updated": "2007-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AR",
            "license": "SP 890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mainline Health Systems, Inc (Lake Village OB Clinic)
• Amy Kniss Mallett, PHARM.D.
• Brenda F. Matthews
• Maxus Inc. (Arkansas Counseling Associates)
• Michael Bradley Mayfield, M.D.
• Melody A McAffery, SLP
• Lekasha McClinton
• Maury Bruton McCord, LAC
• Kristina McIntyre
• Tequeshia Z McKoy, AT

• Speech-Language Pathologist in Lake Village, AR
• Providers in Lake Village, AR by specialty
• Speech-Language Pathologist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.