Provider Demographics
NPI:1316190135
Name:OLIVERI, JAIME LYNN (MSED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:LYNN
Last Name:OLIVERI
Suffix:
Gender:F
Credentials:MSED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2818
Mailing Address - Country:US
Mailing Address - Phone:212-691-1183
Mailing Address - Fax:
Practice Address - Street 1:490 HUDSON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-2818
Practice Address - Country:US
Practice Address - Phone:212-691-1183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017425-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03653312Medicare Oscar/Certification