Provider Demographics
NPI:1275773814
Name:HEBL, JAMI M (MS)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:M
Last Name:HEBL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JAMI
Other - Middle Name:M
Other - Last Name:CUSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:626 E SLIFER ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-1224
Mailing Address - Country:US
Mailing Address - Phone:608-742-8811
Mailing Address - Fax:
Practice Address - Street 1:626 E SLIFER ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-1224
Practice Address - Country:US
Practice Address - Phone:608-742-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1720-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist