=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003274952
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMI LYNN JAMIESON L.C.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2016
-----------------------------------------------------
Last Update Date | 07/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 S GRAND AVE WEST
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62704-3838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-744-3525
-----------------------------------------------------
Fax | 217-744-3535
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 S GRAND AVE WEST
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62704-3838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-744-3525
-----------------------------------------------------
Fax | 217-744-3535
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149.017908
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------