Healthcare Provider Details

I. General information

NPI: 1699347591
Provider Name (Legal Business Name): JAMIE LYNN HAGAMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30150 CAMPBELL RD
MADISON HEIGHTS MI
48071-4497
US

IV. Provider business mailing address

30150 CAMPBELL RD
MADISON HEIGHTS MI
48071-4462
US

V. Phone/Fax

Practice location:
  • Phone: 248-589-0556
  • Fax:
Mailing address:
  • Phone: 248-589-0556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101008286
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: