Provider Demographics
NPI:1851743280
Name:GRASSO, JAMIE (MA CCC-SLP, PC, LSLS)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:
Last Name:GRASSO
Suffix:
Gender:F
Credentials:MA CCC-SLP, PC, LSLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LONGVIEW TRL W
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2021
Mailing Address - Country:US
Mailing Address - Phone:551-497-0641
Mailing Address - Fax:973-453-6869
Practice Address - Street 1:124 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2100
Practice Address - Country:US
Practice Address - Phone:551-497-0641
Practice Address - Fax:973-453-6869
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00516400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist