Provider Demographics
NPI:1629553904
Name:HAYNIE, ELIZABETH RHOADS (CCC-SLP, PTA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RHOADS
Last Name:HAYNIE
Suffix:
Gender:F
Credentials:CCC-SLP, PTA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CLAIRE
Other - Last Name:RHOADS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:48 W COLT SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2813
Mailing Address - Country:US
Mailing Address - Phone:479-582-2740
Mailing Address - Fax:479-582-2746
Practice Address - Street 1:2005 S 12TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-6307
Practice Address - Country:US
Practice Address - Phone:479-877-1794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA4392225200000X
AR202601235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant