Provider Demographics
NPI:1225283682
Name:JAMESON, BOBBIE
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:
Last Name:JAMESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8629 W ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3519
Mailing Address - Country:US
Mailing Address - Phone:623-521-9140
Mailing Address - Fax:
Practice Address - Street 1:8629 W ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3519
Practice Address - Country:US
Practice Address - Phone:623-521-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No385H00000XRespite Care FacilityRespite Care