Provider Demographics
NPI:1609145473
Name:PARKS, JAMIE (DEVELOPMENTAL SPEC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:DEVELOPMENTAL SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:NEW MARSHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45766-0270
Mailing Address - Country:US
Mailing Address - Phone:304-488-6759
Mailing Address - Fax:
Practice Address - Street 1:1400 HOCKING ST
Practice Address - Street 2:
Practice Address - City:NEW MARSHFIELD
Practice Address - State:OH
Practice Address - Zip Code:45766-9735
Practice Address - Country:US
Practice Address - Phone:304-488-6759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency