Basic Information
| Provider Information | |||||||||
| NPI: | 1609438621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DISALVO | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | MS, CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7000 W 121ST ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662092011 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7000 W 121ST ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662092011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9139122174 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2019 | ||||||||
| LastUpdateDate: | 11/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 14227646 | 01 | NY | ASHA CERTIFICATION | OTHER |