Provider Demographics
NPI:1154632925
Name:OPENDEN, JAIME NICOLE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JAIME
Middle Name:NICOLE
Last Name:OPENDEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5847 FRANCIS LEWIS BLVD
Mailing Address - Street 2:SUITE NUMBER 15
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1698
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5847 FRANCIS LEWIS BLVD
Practice Address - Street 2:SUITE NUMBER 15
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-1698
Practice Address - Country:US
Practice Address - Phone:718-943-6202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018097-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist