Individual
JAMIE M. STICKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
100 NAVARRE PL STE 4460, SOUTH BEND, IN 46601-1168
(574) 235-1010
(574) 232-2064
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
23002348A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200980700
—
IN
01
—
261970156
MEDICARE PTAN
IN
Enumeration date
06/29/2006
Last updated
01/18/2022
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