Provider Demographics
NPI:1548415292
Name:RESTREPO, JAIME ENRIQUE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:ENRIQUE
Last Name:RESTREPO
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Gender:M
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:6738 108TH ST
Mailing Address - Street 2:A46
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2355
Mailing Address - Country:US
Mailing Address - Phone:718-786-6760
Mailing Address - Fax:718-786-6760
Practice Address - Street 1:6738 108TH ST
Practice Address - Street 2:A46
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2355
Practice Address - Country:US
Practice Address - Phone:718-786-6760
Practice Address - Fax:718-786-6760
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-22
Last Update Date:2011-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY012823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist