Provider Demographics
NPI:1407337918
Name:KLINGINSMITH, JAMIE DAWN
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:DAWN
Last Name:KLINGINSMITH
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 1:6914 W COLTER ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-5819
Mailing Address - Country:US
Mailing Address - Phone:623-235-1446
Mailing Address - Fax:
Practice Address - Street 1:5270 N 59TH AVE STE 9
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-6763
Practice Address - Country:US
Practice Address - Phone:623-235-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ61-1885971221700000X, 373H00000X, 225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist