Healthcare Provider Details

I. General information

NPI: 1972750958
Provider Name (Legal Business Name): DOREEN DIANN JAMES MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 RISEN SON BLVD
COUNCIL BLUFFS IA
51503-1911
US

IV. Provider business mailing address

208 MEADOW LN P.O. BOX 565
TREYNOR IA
51575-7106
US

V. Phone/Fax

Practice location:
  • Phone: 712-366-9655
  • Fax:
Mailing address:
  • Phone: 712-487-3467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number001839
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: