Provider Demographics
NPI:1437677416
Name:GARRETT, JAMIE RENEE
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:RENEE
Last Name:GARRETT
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 1:759 N 1350 EAST RD
Mailing Address - Street 2:
Mailing Address - City:OWANECO
Mailing Address - State:IL
Mailing Address - Zip Code:62555-5517
Mailing Address - Country:US
Mailing Address - Phone:217-972-8534
Mailing Address - Fax:
Practice Address - Street 1:805 N CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-1450
Practice Address - Country:US
Practice Address - Phone:217-824-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007898235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist