Provider Demographics
NPI:1629207980
Name:KEITH, JAMIE ANN (LICENSED SPEECH PATH)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:ANN
Last Name:KEITH
Suffix:
Gender:F
Credentials:LICENSED SPEECH PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16891 ESTRELLA DRIVE
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-3107
Mailing Address - Country:US
Mailing Address - Phone:707-996-7527
Mailing Address - Fax:707-996-1357
Practice Address - Street 1:16891 ESTRELLA DRIVE
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-3107
Practice Address - Country:US
Practice Address - Phone:707-996-7527
Practice Address - Fax:707-996-1357
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist