Provider Demographics
NPI:1053576413
Name:JAMIESON, KRISTIN A (MA CCC/SLP NYS LIC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:A
Last Name:JAMIESON
Suffix:
Gender:F
Credentials:MA CCC/SLP NYS LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 QUAKER LAKE TER
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2800
Mailing Address - Country:US
Mailing Address - Phone:716-662-3769
Mailing Address - Fax:
Practice Address - Street 1:72 QUAKER LAKE TER
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2800
Practice Address - Country:US
Practice Address - Phone:716-662-3769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0080041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist