Provider Demographics
NPI:1346331907
Name:BACKMAN, JAIME NICOLE (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:NICOLE
Last Name:BACKMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9090 CATTAIL RUN
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2893
Mailing Address - Country:US
Mailing Address - Phone:954-254-1994
Mailing Address - Fax:
Practice Address - Street 1:9090 CATTAIL RUN
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-2893
Practice Address - Country:US
Practice Address - Phone:954-254-1994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8207235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889535300Medicaid