MEDICARE: MRS. JAIME G. GORBY M.A., CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	A-0127	WV

General Provider Information

NPI Number	:	1760515100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAIME G. GORBY M.A., CCC-A

Provider Business Mailing Address
First Line	:	500 DONNALLY ST
Second Line	:	SUITE 102
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1648
Country	:	US
Telephone Number	:	304-340-2209
Fax Number	:	304-340-2204

Provider Business Practice Location Address
First Line	:	500 DONNALLY ST
Second Line	:	SUITE 102
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1648
Country	:	US
Telephone Number	:	304-340-2209
Fax Number	:	304-340-2204

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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