Provider Demographics
NPI:1457679607
Name:BIRD, JAIMI N (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAIMI
Middle Name:N
Last Name:BIRD
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 1:170 SE CRABAPPLE DR
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8175
Mailing Address - Country:US
Mailing Address - Phone:515-987-2131
Mailing Address - Fax:
Practice Address - Street 1:170 SE CRABAPPLE DR
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8175
Practice Address - Country:US
Practice Address - Phone:515-987-2131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01424235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist