Provider Demographics
NPI:1871096529
Name:NOVITSKY, JAMIE LEIGH (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEIGH
Last Name:NOVITSKY
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 1:1404 SPRING RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3781
Mailing Address - Country:US
Mailing Address - Phone:254-721-9976
Mailing Address - Fax:
Practice Address - Street 1:3605 YUCCA DR STE 102
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2753
Practice Address - Country:US
Practice Address - Phone:972-874-9400
Practice Address - Fax:972-874-9455
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110459235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty