Provider Demographics
NPI:1003645078
Name:STANIEWICZ, JAMIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:STANIEWICZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2587 JUSTINE LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2582
Mailing Address - Country:US
Mailing Address - Phone:561-371-0526
Mailing Address - Fax:
Practice Address - Street 1:2587 JUSTINE LN
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2582
Practice Address - Country:US
Practice Address - Phone:561-371-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17436235Z00000X
WALL60336071235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist