MEDICARE: MRS. JAMIE RAE MENDELL M.A CCC-SLP

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	235Z00000X	Speech-Language Pathologist	14094446	CO

General Provider Information

NPI Number	:	1992195390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE RAE MENDELL M.A CCC-SLP

Provider Business Mailing Address
First Line	:	3665 HEATHER GLEN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-3113
Country	:	US
Telephone Number	:	719-237-2038
Fax Number	:

Provider Business Practice Location Address
First Line	:	3665 HEATHER GLEN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-3113
Country	:	US
Telephone Number	:	719-237-2038
Fax Number	:

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

Provider Enumeration Date	:	01/23/2015
Last Update Date	:	01/23/2015

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