Provider Demographics
NPI:1023242575
Name:RIESS, JAMIE LEIGH (MA CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:LEIGH
Last Name:RIESS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 WOODFORD LN
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-3628
Mailing Address - Country:US
Mailing Address - Phone:609-267-2329
Mailing Address - Fax:
Practice Address - Street 1:15 SUNSET RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-4151
Practice Address - Country:US
Practice Address - Phone:609-387-3620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00574500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist