Provider Demographics
NPI:1255589008
Name:WALL, JAMIE LYNN (AUD, CCC/A)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:WALL
Suffix:
Gender:F
Credentials:AUD, CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21715 KINGSLAND BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2544
Mailing Address - Country:US
Mailing Address - Phone:281-578-7500
Mailing Address - Fax:281-492-9204
Practice Address - Street 1:21715 KINGSLAND BLVD STE 105
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2544
Practice Address - Country:US
Practice Address - Phone:281-578-7500
Practice Address - Fax:281-492-9204
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA3560237600000X
LA5525237600000X
TX80551237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter