Provider Demographics
NPI:1467732784
Name:FOREMAN, JAMILA PERRY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAMILA
Middle Name:PERRY
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 COLEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-3840
Mailing Address - Country:US
Mailing Address - Phone:336-624-0030
Mailing Address - Fax:
Practice Address - Street 1:4343 COLEBROOK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3840
Practice Address - Country:US
Practice Address - Phone:336-624-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8762235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist