Provider Demographics
NPI:1730338922
Name:LONGORIA, JAMIE (SLP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:LONGORIA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W 3RD AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-4564
Mailing Address - Country:US
Mailing Address - Phone:903-872-5925
Mailing Address - Fax:
Practice Address - Street 1:500 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4562
Practice Address - Country:US
Practice Address - Phone:903-872-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103717235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103717OtherTX SLP