Provider Demographics
NPI:1790925139
Name:GOSSETT, JAMIE (SPEECH THERAPIST)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GOSSETT
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1155
Mailing Address - Street 2:
Mailing Address - City:NORRIS
Mailing Address - State:TN
Mailing Address - Zip Code:37828-1155
Mailing Address - Country:US
Mailing Address - Phone:865-805-5903
Mailing Address - Fax:865-378-8591
Practice Address - Street 1:115 OAK RD STE 107
Practice Address - Street 2:
Practice Address - City:NORRIS
Practice Address - State:TN
Practice Address - Zip Code:37828-3051
Practice Address - Country:US
Practice Address - Phone:865-805-5903
Practice Address - Fax:865-378-8591
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3459235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN446655Medicare PIN