Healthcare Provider Details

I. General information

NPI: 1790457182
Provider Name (Legal Business Name): JAMIE HERMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 CLUB MANOR DR
PUEBLO CO
81008-2004
US

IV. Provider business mailing address

247 E MAHER CT
PUEBLO WEST CO
81007-1609
US

V. Phone/Fax

Practice location:
  • Phone: 817-925-7956
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number119029
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0007039
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: