Provider Demographics
NPI:1104062330
Name:IPOCK, JAMIE SHEREE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:SHEREE
Last Name:IPOCK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-9386
Mailing Address - Country:US
Mailing Address - Phone:417-753-3628
Mailing Address - Fax:
Practice Address - Street 1:203 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65742-9386
Practice Address - Country:US
Practice Address - Phone:417-753-3628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004012583235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist