Provider Demographics
NPI:1538661764
Name:RELERFORD, JASON LAMAR
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LAMAR
Last Name:RELERFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3081 W DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-2423
Mailing Address - Country:US
Mailing Address - Phone:810-342-8842
Mailing Address - Fax:
Practice Address - Street 1:4121 M L KING AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-3707
Practice Address - Country:US
Practice Address - Phone:810-342-8842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-04
Last Update Date:2018-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist