Provider Demographics
NPI:1326377672
Name:VICHINSKY, JAMIE DEVORAH (SLP/CCC)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:DEVORAH
Last Name:VICHINSKY
Suffix:
Gender:F
Credentials:SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805
Mailing Address - Country:US
Mailing Address - Phone:914-922-9333
Mailing Address - Fax:914-922-9336
Practice Address - Street 1:333 PELHAM RD,
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805
Practice Address - Country:US
Practice Address - Phone:914-922-9333
Practice Address - Fax:914-922-9336
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP-7864-SL235Z00000X
NY015967-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist