Provider Demographics
NPI:1356758353
Name:SPOHN, JAMIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:SPOHN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:JURBALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:121 HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:OWINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20736-3430
Mailing Address - Country:US
Mailing Address - Phone:407-617-2003
Mailing Address - Fax:
Practice Address - Street 1:121 HONEYSUCKLE LN
Practice Address - Street 2:
Practice Address - City:OWINGS
Practice Address - State:MD
Practice Address - Zip Code:20736-3430
Practice Address - Country:US
Practice Address - Phone:407-617-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000896103T00000X
MD05590103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist