Provider Demographics
NPI:1215487988
Name:HAYWOOD, JAIME C (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:C
Last Name:HAYWOOD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9142 MOUNTAIN SUNRISE ST SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-8772
Mailing Address - Country:US
Mailing Address - Phone:801-839-9492
Mailing Address - Fax:
Practice Address - Street 1:216 E 4TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3200
Practice Address - Country:US
Practice Address - Phone:360-457-8575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60279050235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist