Basic Information
| Provider Information | |||||||||
| NPI: | 1154849586 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROCHE | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | ALLISON | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 459 PHILO RD | ||||||||
| Address2: | |||||||||
| City: | ELMIRA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 149031051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077393581 | ||||||||
| FaxNumber: | 6077955304 | ||||||||
| Practice Location | |||||||||
| Address1: | 1126 BALD HILL RD | ||||||||
| Address2: | |||||||||
| City: | HORNELL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148431262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6073247880 | ||||||||
| FaxNumber: | 6077955304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2017 | ||||||||
| LastUpdateDate: | 09/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 026768 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.