Healthcare Provider Details

I. General information

NPI: 1699327767
Provider Name (Legal Business Name): JAMIE ALISSA EPSTEIN M.A. CCC-SLP, TSSLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E BETHPAGE RD STE 5
PLAINVIEW NY
11803-4228
US

IV. Provider business mailing address

30 MARSHMALLOW DR
COMMACK NY
11725-1023
US

V. Phone/Fax

Practice location:
  • Phone: 516-731-5588
  • Fax:
Mailing address:
  • Phone: 631-946-4650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number029939
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: