Provider Demographics
NPI:1518018035
Name:MASSEY, JAMIE SUZANNE (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:SUZANNE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:SUZANNE
Other - Last Name:DAUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:750 N COMMONS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7940
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:630-303-5385
Practice Address - Street 1:7103 SAN PEDRO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6219
Practice Address - Country:US
Practice Address - Phone:210-348-5556
Practice Address - Fax:210-348-5449
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X
TX51677231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB128910Medicare PIN