Provider Demographics
NPI:1164673356
Name:DEIBERT-DADFAR, JAIMIE LYNNE (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:MS
First Name:JAIMIE
Middle Name:LYNNE
Last Name:DEIBERT-DADFAR
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:JAIMIE
Other - Middle Name:LYNNE
Other - Last Name:DEIBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, SLP
Mailing Address - Street 1:1401 W PECAN ST
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2518
Mailing Address - Country:US
Mailing Address - Phone:512-594-0000
Mailing Address - Fax:
Practice Address - Street 1:1401A W PECAN ST
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2518
Practice Address - Country:US
Practice Address - Phone:512-594-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1740323161Medicaid