MEDICARE: DR. JAMIE BRYNN GAITHER PHD, NCSP

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	103TS0200X	School Psychologist	10316408	IN

General Provider Information

NPI Number	:	1619790995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMIE BRYNN GAITHER PHD, NCSP

Provider Business Mailing Address
First Line	:	315 E NORTH DR
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-6595
Country	:	US
Telephone Number	:	812-330-7745
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 E NORTH DR
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-6595
Country	:	US
Telephone Number	:	812-330-7745
Fax Number	:

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

Provider Enumeration Date	:	11/05/2024
Last Update Date	:	11/05/2024

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