Provider Demographics
NPI:1760515100
Name:GORBY, JAIME G (MA, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:G
Last Name:GORBY
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 DONNALLY ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1648
Mailing Address - Country:US
Mailing Address - Phone:304-340-2209
Mailing Address - Fax:304-340-2204
Practice Address - Street 1:500 DONNALLY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1648
Practice Address - Country:US
Practice Address - Phone:304-340-2209
Practice Address - Fax:304-340-2204
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-0127231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist