Active NPI
Jamie Odelle Van Wyk, SLPA
- Speech-Language Pathologist
- Timonium, MD
National Provider Identifier
1972350080
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 00151
- Practice address
- 1818 Pot Spring Rd
Timonium, MD 21093-4445 - Phone
- (410) 583-5765
- Fax
- (410) 583-5765
- NPI assigned
- May 6, 2024
- Last updated
- May 11, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 00151 | MD | Primary |
Addresses
Primary practice location
1818 Pot Spring Rd
Timonium, MD 21093-4445
Mailing address
1818 Pot Spring Rd
Timonium, MD 21093-4445
Phone (410) 583-5765
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00151 | MD | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715385600000",
"number": "1972350080",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1818 POT SPRING RD",
"city": "TIMONIUM",
"state": "MD",
"postal_code": "210934445",
"telephone_number": "410-583-5765"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1818 POT SPRING RD",
"city": "TIMONIUM",
"state": "MD",
"postal_code": "210934445",
"telephone_number": "410-583-5765",
"fax_number": "410-583-5765"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN WYK",
"first_name": "JAMIE",
"middle_name": "ODELLE",
"credential": "SLPA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-05-06",
"last_updated": "2024-05-11",
"certification_date": "2024-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MD",
"license": "00151",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Timonium, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.