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General NPI Number Information
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NPI Number | 1235704644
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Entity Type | Individual
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Provider Name | JAMIE ROSE SCHLIES CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 2200 NEVADA AVE S
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City | ST LOUIS PARK
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State | MN
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Zip | 55426-2659
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Country | US
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Telephone | 920-676-2722
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Fax |
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Provider Business Mailing Address
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Address Line | 1635 SWAN RD APT 9
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City | DE PERE
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State | WI
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Zip | 54115-4037
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Country | US
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Telephone | 920-676-2722
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 165042
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 479528
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License Number State | MN
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