Provider Demographics
NPI:1437462447
Name:STALLS, JAMIE ROUSE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ROUSE
Last Name:STALLS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 HICKORY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-6321
Mailing Address - Country:US
Mailing Address - Phone:864-426-2673
Mailing Address - Fax:864-752-1072
Practice Address - Street 1:1980 HICKORY GROVE ROAD
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-6321
Practice Address - Country:US
Practice Address - Phone:864-426-2673
Practice Address - Fax:864-752-1072
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist