Provider Demographics
NPI:1558894394
Name:TODD, JAMIE (MA SLP-CCC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:MA SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12429 S 2075 W
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-4353
Mailing Address - Country:US
Mailing Address - Phone:801-913-9475
Mailing Address - Fax:
Practice Address - Street 1:12429 S 2075 W
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-4353
Practice Address - Country:US
Practice Address - Phone:801-913-9475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-08
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT543697235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist