Provider Demographics
NPI:1932446689
Name:CULLEN, JAMIE MARIE (MA,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:MARIE
Last Name:CULLEN
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:MARIE
Other - Last Name:BOLGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,CCC-SLP
Mailing Address - Street 1:1101 E. STATE STREET
Mailing Address - Street 2:GENEVA NURSING AND REHABILITATION
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 E STATE ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2438
Practice Address - Country:US
Practice Address - Phone:630-397-5409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009542235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist