Provider Demographics
NPI:1043565450
Name:WOODRUM, JAMIE VICTORIA
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:VICTORIA
Last Name:WOODRUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3353 S EMERALD AVE
Mailing Address - Street 2:APT. 1R
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4485
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3353 S EMERALD AVE
Practice Address - Street 2:APT. 1R
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4485
Practice Address - Country:US
Practice Address - Phone:312-451-2802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242002335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist