Provider Demographics
NPI:1972805042
Name:WINTERS, JERRI JO (MCD, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JERRI
Middle Name:JO
Last Name:WINTERS
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4729 INVERNESS RUN DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-8062
Mailing Address - Country:US
Mailing Address - Phone:870-761-3783
Mailing Address - Fax:
Practice Address - Street 1:3423 E HIGHLAND DR
Practice Address - Street 2:STE. A
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6404
Practice Address - Country:US
Practice Address - Phone:870-336-0021
Practice Address - Fax:870-336-0022
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP #789235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist