Provider Demographics
NPI:1821353640
Name:TETTEY, JAMIE R (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:R
Last Name:TETTEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:R
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:5587 CALLCOTT WAY
Mailing Address - Street 2:UNIT 1201
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-4009
Mailing Address - Country:US
Mailing Address - Phone:757-218-3951
Mailing Address - Fax:
Practice Address - Street 1:7520 SURRATTS RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3353
Practice Address - Country:US
Practice Address - Phone:301-856-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06700235Z00000X
VA2202006609235Z00000X
DC00048235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist