Healthcare Provider Details

I. General information

NPI: 1760145825
Provider Name (Legal Business Name): JAIMI POLLACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7420 FULLERTON RD STE 110
SPRINGFIELD VA
22153-2836
US

IV. Provider business mailing address

5132 N PALM AVE
FRESNO CA
93704-2236
US

V. Phone/Fax

Practice location:
  • Phone: 301-477-7194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: