Healthcare Provider Details

I. General information

NPI: 1821644907
Provider Name (Legal Business Name): JAMIE RYCKMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 VETERANS WAY
ORLANDO FL
32827-7401
US

IV. Provider business mailing address

14056 NEWCOMB AVE
ORLANDO FL
32826-3407
US

V. Phone/Fax

Practice location:
  • Phone: 407-631-1100
  • Fax:
Mailing address:
  • Phone: 954-790-2049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ9132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: