Provider Demographics
NPI:1649767674
Name:PARKHURST, JAMY L (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:JAMY
Middle Name:L
Last Name:PARKHURST
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 PARK ST
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:ME
Mailing Address - Zip Code:04930-1470
Mailing Address - Country:US
Mailing Address - Phone:207-924-5516
Mailing Address - Fax:207-924-8817
Practice Address - Street 1:64 PARK ST
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:ME
Practice Address - Zip Code:04930-1470
Practice Address - Country:US
Practice Address - Phone:207-924-5516
Practice Address - Fax:207-924-8817
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2326235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist