Jaime Dawdy, MA, CCC-SLP

Key facts

NPI

1154878262

Entity type

Individual (NPI type 1)

Primary specialty

Speech-Language Pathologist 235Z00000X

License

7101002112 (MI)

Practice address

7800 W Outer Dr Ste 300
Detroit, MI 48235-3458

Phone

(313) 340-4442

NPI assigned

Sep 7, 2016

Sex

Female

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Psygenics Inc Clinical Social Worker · Dearborn, MI · NPI 1669736104
  Medicare reassignment Care Compare group MI

Medicare Care Compare profile

Specialty

Qualified Speech Language Pathologist

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Psygenics Inc (8 clinicians)

Practice addresses (Care Compare)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in MI

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Master of Arts

State licenses

Specialties & licenses

Addresses

Other names

• Jaime Bortnick Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 17, 2019.

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563321600000",
    "number": "1154878262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7800 W OUTER DR STE 300",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482353458",
            "telephone_number": "313-340-4442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7800 W OUTER DR STE 300",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482353458",
            "telephone_number": "313-340-4442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11000 West McNichols",
            "address_2": "Suite 320",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "48221",
            "country_code": "US",
            "telephone_number": "313-340-4442",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAWDY",
        "first_name": "JAIME",
        "credential": "MA, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-07",
        "last_updated": "2019-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": "7101002112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAIME",
            "last_name": "BORTNICK",
            "credential": "MA, CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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