Provider Demographics
NPI:1932757895
Name:HARVEY, JAY RICHARD (SLPA)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:RICHARD
Last Name:HARVEY
Suffix:
Gender:M
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5804 ARROYO DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-5008
Mailing Address - Country:US
Mailing Address - Phone:303-709-1449
Mailing Address - Fax:
Practice Address - Street 1:5300 FOOTHILLS DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-8279
Practice Address - Country:US
Practice Address - Phone:505-599-8604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLPA61432355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant