Provider Demographics
NPI:1821623109
Name:SCHWARTZ, JAMIE (SLP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:SCHWARTZ
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 1:4900 NW 115TH WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3208
Mailing Address - Country:US
Mailing Address - Phone:954-632-8724
Mailing Address - Fax:
Practice Address - Street 1:5400 S UNIVERSITY DR STE 215A
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5310
Practice Address - Country:US
Practice Address - Phone:954-319-7609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-07
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17788Medicaid