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General NPI Number Information
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NPI Number | 1316394034
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Entity Type | Individual
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Provider Name | JAMIE NIEDRICH
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Gender | Female
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 4242 LINDELL BLVD APT 217
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2984
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Country | US
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Telephone | 435-799-4663
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Fax |
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Provider Business Mailing Address
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Address Line | 40 S 100 E APT 2
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City | HYDE PARK
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State | UT
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Zip | 84318-3207
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Country | US
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Telephone | 435-799-4663
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Fax | 435-514-5383
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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 | 2015033016
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License Number State | MO
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