Provider Demographics
NPI:1639535107
Name:DOBROVOLC, JAMIE L (MS ED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:DOBROVOLC
Suffix:
Gender:F
Credentials:MS ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13807-0532
Mailing Address - Country:US
Mailing Address - Phone:607-206-0707
Mailing Address - Fax:
Practice Address - Street 1:42 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NY
Practice Address - Zip Code:13807
Practice Address - Country:US
Practice Address - Phone:607-286-3349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025367235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist