Provider Demographics
NPI:1831444116
Name:FITTERER, JAMIE LYNN
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYNN
Last Name:FITTERER
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 1:2266 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-4705
Mailing Address - Country:US
Mailing Address - Phone:618-877-1184
Mailing Address - Fax:618-798-4287
Practice Address - Street 1:2266 MADISON AVE
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-4705
Practice Address - Country:US
Practice Address - Phone:618-877-1184
Practice Address - Fax:618-798-4287
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008145101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional