Provider Demographics
NPI:1588079313
Name:BARROSO, JAMIE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:BARROSO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6930 LE GRAND RD
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-9277
Mailing Address - Country:US
Mailing Address - Phone:559-901-9650
Mailing Address - Fax:209-722-6347
Practice Address - Street 1:6930 LE GRAND RD
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-9277
Practice Address - Country:US
Practice Address - Phone:559-901-9650
Practice Address - Fax:209-722-6347
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12967235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist