Provider Demographics
NPI:1659608107
Name:GENTRY, JAMY LIANE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAMY
Middle Name:LIANE
Last Name:GENTRY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 E 21ST ST
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:810 E 21ST ST
Practice Address - Street 2:SUITE 6A
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4442
Practice Address - Country:US
Practice Address - Phone:575-763-9517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist