Provider Demographics
NPI:1316394034
Name:NIEDRICH, JAMIE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:NIEDRICH
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 1:40 S 100 E APT 2
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84318-3207
Mailing Address - Country:US
Mailing Address - Phone:435-799-4663
Mailing Address - Fax:435-514-5383
Practice Address - Street 1:4242 LINDELL BLVD APT 217
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2984
Practice Address - Country:US
Practice Address - Phone:435-799-4663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015033016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist