Provider Demographics
NPI:1508497892
Name:GRIFFIN, JAMIE LEN
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEN
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JAMIE
Other - Middle Name:LEN
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:256 W 100 S
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-5231
Mailing Address - Country:US
Mailing Address - Phone:435-265-0925
Mailing Address - Fax:
Practice Address - Street 1:256 W 100 S
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5231
Practice Address - Country:US
Practice Address - Phone:435-265-0925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist