Provider Demographics
NPI:1447407127
Name:BEARDSLEY, JAIME D (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:D
Last Name:BEARDSLEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5276 HALL RD
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14735-8745
Mailing Address - Country:US
Mailing Address - Phone:585-567-8299
Mailing Address - Fax:585-567-8882
Practice Address - Street 1:5276 HALL RD
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:NY
Practice Address - Zip Code:14735-8745
Practice Address - Country:US
Practice Address - Phone:585-567-8299
Practice Address - Fax:585-567-8882
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017039-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist