Basic Information
| Provider Information | |||||||||
| NPI: | 1922551845 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SURELL | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S.,CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14409 GREENVIEW DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207083293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014988100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14409 GREENVIEW DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207083293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014988100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2016 | ||||||||
| LastUpdateDate: | 07/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 07490 | MD | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.