MEDICARE: JAMIES SPEAKEASY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1528823010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMIES SPEAKEASY LLC

Provider Business Mailing Address
First Line	:	174 HIGH ST
Second Line	:
City	:	SAINT ALBANS
State	:	VT
Zip	:	05478-1580
Country	:	US
Telephone Number	:	716-597-8353
Fax Number	:

Provider Business Practice Location Address
First Line	:	174 HIGH ST
Second Line	:
City	:	SAINT ALBANS
State	:	VT
Zip	:	05478-1580
Country	:	US
Telephone Number	:	716-597-8353
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	JAMIE LYNN BROOKS-NOWAK
Credential	:	CCC-SLP
Telephone Number	:	716-597-8353

Provider Enumeration Date	:	02/14/2024
Last Update Date	:	02/14/2024

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Directions to “JAMIES SPEAKEASY LLC ” Practice Location

Language	Start Address	Practice Location

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