Provider Demographics
NPI:1841682606
Name:TUAZON, JAMIE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:TUAZON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:LOOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:25 SIOUX ST
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1841
Mailing Address - Country:US
Mailing Address - Phone:732-740-6223
Mailing Address - Fax:
Practice Address - Street 1:1328 N 31ST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-4425
Practice Address - Country:US
Practice Address - Phone:732-740-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PASL012825235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program