Provider Demographics
NPI:1245973783
Name:AVENALL, JAIME CLARISE
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:CLARISE
Last Name:AVENALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 MOUNTAIN SHADOW DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-3838
Mailing Address - Country:US
Mailing Address - Phone:218-722-6611
Mailing Address - Fax:800-856-4807
Practice Address - Street 1:2216 MOUNTAIN SHADOW DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-3838
Practice Address - Country:US
Practice Address - Phone:218-722-6611
Practice Address - Fax:800-856-4807
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist