Provider Demographics
NPI:1235704644
Name:SCHLIES, JAMIE ROSE (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:ROSE
Last Name:SCHLIES
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 1:1635 SWAN RD APT 9
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-4037
Mailing Address - Country:US
Mailing Address - Phone:920-676-2722
Mailing Address - Fax:
Practice Address - Street 1:2200 NEVADA AVE S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-2659
Practice Address - Country:US
Practice Address - Phone:920-676-2722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK165042235Z00000X
MN479528235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist