Provider Demographics
NPI:1508299058
Name:LUNDRY, JAIME LYNN (SLP)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:LYNN
Last Name:LUNDRY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 60 BOX 21
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737-9508
Mailing Address - Country:US
Mailing Address - Phone:580-977-9015
Mailing Address - Fax:
Practice Address - Street 1:HC 60 BOX 21
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OK
Practice Address - Zip Code:73737-9508
Practice Address - Country:US
Practice Address - Phone:580-977-9015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3621235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist