Provider Demographics
NPI:1629255518
Name:WEATHERFORD, JAMMIE PATRICIA (MS CCP SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAMMIE
Middle Name:PATRICIA
Last Name:WEATHERFORD
Suffix:
Gender:F
Credentials:MS CCP SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#1 JOHN MARSHALL DR
Mailing Address - Street 2:MARSHALL UNIVERSITY SPEECH AND HEARING CENTER
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25755-2675
Mailing Address - Country:US
Mailing Address - Phone:304-696-3641
Mailing Address - Fax:304-696-2986
Practice Address - Street 1:#1 JOHN MARSHALL DR
Practice Address - Street 2:MARSHALL UNIVERSITY SPEECH AND HEARING CENTER
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25755-2675
Practice Address - Country:US
Practice Address - Phone:304-696-3641
Practice Address - Fax:304-696-2986
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12026355235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010438Medicaid