Provider Demographics
NPI:1043582612
Name:MONROE, JAIMIE L (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAIMIE
Middle Name:L
Last Name:MONROE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:JAIMIE
Other - Middle Name:LIND
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:7722 S 173RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1156
Mailing Address - Country:US
Mailing Address - Phone:402-525-1530
Mailing Address - Fax:402-343-1278
Practice Address - Street 1:7722 S 173RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136-1156
Practice Address - Country:US
Practice Address - Phone:402-525-1530
Practice Address - Fax:402-343-1278
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12122152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist