Provider Demographics
NPI:1457898181
Name:SCANLAN, JAMIE L (SLP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:SCANLAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:CARLTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1200 PLEASANT STREET
Mailing Address - Street 2:SOUTH 2 ROOM 236
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1406
Mailing Address - Country:US
Mailing Address - Phone:515-241-6228
Mailing Address - Fax:515-241-8685
Practice Address - Street 1:2006 S ANKENY BLVD BLDG 5
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-8995
Practice Address - Country:US
Practice Address - Phone:515-289-9541
Practice Address - Fax:515-446-3642
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01552235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1457898181Medicaid