Provider Demographics
NPI:1912150871
Name:HURST-LARSON, JAMIE S (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:S
Last Name:HURST-LARSON
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 HILLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-1588
Mailing Address - Country:US
Mailing Address - Phone:706-860-9385
Mailing Address - Fax:706-868-5624
Practice Address - Street 1:229 HILLBROOK DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-1588
Practice Address - Country:US
Practice Address - Phone:706-860-9385
Practice Address - Fax:706-868-5624
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist