Provider Demographics
NPI:1457971566
Name:SABELLON, JAMIE LOU MEJORADA (MS CCC- SLP)
Entity Type:Individual
Prefix:
First Name:JAMIE LOU
Middle Name:MEJORADA
Last Name:SABELLON
Suffix:
Gender:F
Credentials:MS CCC- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6418 COLD MOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-5197
Mailing Address - Country:US
Mailing Address - Phone:909-362-2265
Mailing Address - Fax:
Practice Address - Street 1:1760 W 16TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1160
Practice Address - Country:US
Practice Address - Phone:909-787-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14145106235Z00000X
CA27767235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist