Provider Demographics
NPI:1437035219
Name:GAINES, MIA (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 E 6TH ST APT 202
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-2500
Mailing Address - Country:US
Mailing Address - Phone:870-362-9440
Mailing Address - Fax:
Practice Address - Street 1:123 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-2701
Practice Address - Country:US
Practice Address - Phone:501-214-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR203145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist