Provider Demographics
NPI:1124155650
Name:HEMINGWAY, LOUISE H (MCD, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:H
Last Name:HEMINGWAY
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:MRS
Other - First Name:LOUISE
Other - Middle Name:H
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD, CCC-SLP
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:MOUND BAYOU
Mailing Address - State:MS
Mailing Address - Zip Code:38762-0314
Mailing Address - Country:US
Mailing Address - Phone:662-398-5065
Mailing Address - Fax:662-398-5065
Practice Address - Street 1:1902 BROADWAY STREET
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MS
Practice Address - Zip Code:38774-0603
Practice Address - Country:US
Practice Address - Phone:662-398-5065
Practice Address - Fax:662-398-5065
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114791Medicaid