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General NPI Number Information
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NPI Number | 1245496280
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Entity Type | Individual
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Provider Name | JAMIE LYNN VITTUM AU D., CCC-A
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Gender | Female
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 02/21/2021
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Provider Practice Location Address
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Address Line | 6035 FAIRVIEW RD
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City | CHARLOTTE
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State | NC
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Zip | 28210-3256
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Country | US
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Telephone | 704-295-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 20325 N 51ST AVE STE 154
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City | GLENDALE
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State | AZ
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Zip | 85308-4622
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Country | US
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Telephone | 623-900-4740
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Fax | 623-900-4741
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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 | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 230002405A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 11297
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 8228
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License Number State | AZ
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