Basic Information
| Provider Information | |||||||||
| NPI: | 1316941784 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PROCTOR | ||||||||
| FirstName: | JAYMA | ||||||||
| MiddleName: | LAYNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 VICTORY DRIVE | ||||||||
| Address2: | |||||||||
| City: | LIBERTY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163132800 | ||||||||
| FaxNumber: | 8167929819 | ||||||||
| Practice Location | |||||||||
| Address1: | 10038 MANCHESTER RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631221833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149622100 | ||||||||
| FaxNumber: | 3149621991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2005 | ||||||||
| LastUpdateDate: | 10/12/2017 | ||||||||
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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 | 231H00000X | 109228 | MO | N | Speech, Language and Hearing Service Providers | Audiologist | 231HA2500X | 109228 | MO | Y | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Supplier |
No ID Information.