MEDICARE: JAMIE JAMES M.S., CCC-SLP

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588813703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE JAMES M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	111 PALMETTO GLEN DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-1195
Country	:	US
Telephone Number	:	708-275-5447
Fax Number	:

Provider Business Practice Location Address
First Line	:	8703 HIGHWAY 17 BYP S
Second Line	:	SUITE I
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29575-7701
Country	:	US
Telephone Number	:	843-457-1053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	08/18/2010

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