Provider Demographics
NPI:1275391633
Name:ATHERTON, JAMIE THERESA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:THERESA
Last Name:ATHERTON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 HEMLOCK TER
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1530
Mailing Address - Country:US
Mailing Address - Phone:570-954-3582
Mailing Address - Fax:
Practice Address - Street 1:400 S STATE RD STE 220
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-1243
Practice Address - Country:US
Practice Address - Phone:610-356-1991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL017452235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty