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Individual
JAMIE SMALL
Active
Individual
JAMIE SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
508
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
532792
—
MT
01
—
565487
MEDICAID
ID
Enumeration date
09/13/2005
Last updated
04/14/2010
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