Provider Demographics
NPI:1093021248
Name:SUMMITT, JAMIE LYNN (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYNN
Last Name:SUMMITT
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CRUME RD
Mailing Address - Street 2:
Mailing Address - City:VINE GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:40175-1125
Mailing Address - Country:US
Mailing Address - Phone:270-352-7061
Mailing Address - Fax:844-688-4227
Practice Address - Street 1:101 CRUME RD
Practice Address - Street 2:
Practice Address - City:VINE GROVE
Practice Address - State:KY
Practice Address - Zip Code:40175
Practice Address - Country:US
Practice Address - Phone:270-352-7061
Practice Address - Fax:844-688-4227
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY142491235Z00000X
KY3731235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYGNU3-661Medicaid