Provider Demographics
NPI:1740549872
Name:MIALE, JAIME L (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:L
Last Name:MIALE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:LEIGH
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:5101 SW 60TH STREET RD APT 2105
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4712
Mailing Address - Country:US
Mailing Address - Phone:407-247-5250
Mailing Address - Fax:
Practice Address - Street 1:5101 SW 60TH STREET RD APT 2105
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4712
Practice Address - Country:US
Practice Address - Phone:407-247-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16397235Z00000X
12152884235Z00000X
GAPCET001620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA12152884OtherASHA
FLSA16397OtherFLORIDA LICENSURE
GAPCET001620OtherPCE TEMPORARY LICENSE