Provider Demographics
NPI:1952640609
Name:MISNER, JAMIE PATRICIA (SLP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:PATRICIA
Last Name:MISNER
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 1:13 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4544
Mailing Address - Country:US
Mailing Address - Phone:518-761-2025
Mailing Address - Fax:518-761-2035
Practice Address - Street 1:13 LOCUST ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4544
Practice Address - Country:US
Practice Address - Phone:518-761-2025
Practice Address - Fax:518-761-2035
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107339235Z00000X
NY024652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist