Provider Demographics
NPI:1922171040
Name:PYO, JAMIE LEE (MS)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LEE
Last Name:PYO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:BERNAZZOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:141 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:CRESSON
Mailing Address - State:PA
Mailing Address - Zip Code:16630-2122
Mailing Address - Country:US
Mailing Address - Phone:814-949-5540
Mailing Address - Fax:
Practice Address - Street 1:3000 IVYSIDE PARK
Practice Address - Street 2:SHEETZ BUILDING
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-3777
Practice Address - Country:US
Practice Address - Phone:814-949-5540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005073101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional