MEDICARE: JAMIE SUZANNE GENTRY 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	101684	TX

General Provider Information

NPI Number	:	1770154775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE SUZANNE GENTRY M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	4514 MOUNT HOUSTON RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-1440
Country	:	US
Telephone Number	:	281-985-6540
Fax Number	:

Provider Business Practice Location Address
First Line	:	4514 MOUNT HOUSTON RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-1440
Country	:	US
Telephone Number	:	281-985-6540
Fax Number	:

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

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	08/30/2023

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Directions to “ JAMIE SUZANNE GENTRY M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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