Provider Demographics
NPI:1073396099
Name:MARCOTTE, JARED MICHAEL (LHAS-VA)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:MICHAEL
Last Name:MARCOTTE
Suffix:
Gender:M
Credentials:LHAS-VA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 AUDREYS CT SE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5912
Mailing Address - Country:US
Mailing Address - Phone:973-216-7319
Mailing Address - Fax:
Practice Address - Street 1:8301 ARLINGTON BLVD STE 302
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2902
Practice Address - Country:US
Practice Address - Phone:703-204-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA22101002177237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist