Provider Demographics
NPI:1851071104
Name:WASHINGTON, JAMESETTA (SLP-A)
Entity Type:Individual
Prefix:
First Name:JAMESETTA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BOARDMAN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3722
Mailing Address - Country:US
Mailing Address - Phone:843-345-5253
Mailing Address - Fax:
Practice Address - Street 1:27 BOARDMAN RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3722
Practice Address - Country:US
Practice Address - Phone:843-345-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC84232355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty