Basic Information
| Provider Information | |||||||||
| NPI: | 1457898181 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCANLAN | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CARLTON | ||||||||
| OtherFirstName: | JAMIE | ||||||||
| OtherMiddleName: | L | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1200 PLEASANT STREET | ||||||||
| Address2: | SOUTH 2 ROOM 236 | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503091406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152416228 | ||||||||
| FaxNumber: | 5152418685 | ||||||||
| Practice Location | |||||||||
| Address1: | 2006 S ANKENY BLVD BLDG 5 | ||||||||
| Address2: | |||||||||
| City: | ANKENY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500238995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152899541 | ||||||||
| FaxNumber: | 5154463642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 01552 | IA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 1457898181 | 05 | IA | MEDICAID |