Provider Demographics
NPI:1710380217
Name:JAMES, JANE (SLP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:JAMES
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 1:3731 6TH AVE
Mailing Address - Street 2:103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4383
Mailing Address - Country:US
Mailing Address - Phone:619-291-3515
Mailing Address - Fax:619-291-3529
Practice Address - Street 1:3731 6TH AVE
Practice Address - Street 2:103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4383
Practice Address - Country:US
Practice Address - Phone:619-291-3515
Practice Address - Fax:619-291-3529
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP21823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist