Provider Demographics
NPI:1922548221
Name:CUSSEN, JAMIE (MT-BC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:CUSSEN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 E ORCHID CT UNIT C
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3762
Mailing Address - Country:US
Mailing Address - Phone:602-277-5557
Mailing Address - Fax:
Practice Address - Street 1:1551 E ORCHID CT UNIT C
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3762
Practice Address - Country:US
Practice Address - Phone:602-277-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09166225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist