Provider Demographics
NPI:1114316817
Name:TYSON-MCOMIE, JAIMEE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAIMEE
Middle Name:
Last Name:TYSON-MCOMIE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 STRATFORD CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6567
Mailing Address - Country:US
Mailing Address - Phone:208-965-4921
Mailing Address - Fax:
Practice Address - Street 1:509 S EXETER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4365
Practice Address - Country:US
Practice Address - Phone:877-804-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1926235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist