Provider Demographics
NPI:1972750958
Name:JAMES, DOREEN DIANN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:DIANN
Last Name:JAMES
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 1:208 MEADOW LN
Mailing Address - Street 2:P.O. BOX 565
Mailing Address - City:TREYNOR
Mailing Address - State:IA
Mailing Address - Zip Code:51575-7106
Mailing Address - Country:US
Mailing Address - Phone:712-487-3467
Mailing Address - Fax:
Practice Address - Street 1:3000 RISEN SON BLVD
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1911
Practice Address - Country:US
Practice Address - Phone:712-366-9655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001839235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist