Provider Demographics
NPI:1013348796
Name:BOSSART, JAMI (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAMI
Middle Name:
Last Name:BOSSART
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1419
Mailing Address - Country:US
Mailing Address - Phone:618-632-3666
Mailing Address - Fax:
Practice Address - Street 1:118 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1419
Practice Address - Country:US
Practice Address - Phone:618-632-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.005211235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist