Provider Demographics
NPI:1750684437
Name:STARON, JAIME (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:STARON
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 1:117 NW 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:OAK ISLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28465-7018
Mailing Address - Country:US
Mailing Address - Phone:304-488-5620
Mailing Address - Fax:
Practice Address - Street 1:117 NW 10TH ST
Practice Address - Street 2:
Practice Address - City:OAK ISLAND
Practice Address - State:NC
Practice Address - Zip Code:28465-7018
Practice Address - Country:US
Practice Address - Phone:304-488-5620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8158235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist