Provider Demographics
NPI:1083346977
Name:DAIGLE, JAMIE LEE (AUD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 WYOMING AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3970
Mailing Address - Country:US
Mailing Address - Phone:570-714-2656
Mailing Address - Fax:
Practice Address - Street 1:920 WYOMING AVE STE 101
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-3970
Practice Address - Country:US
Practice Address - Phone:570-714-2656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006820231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist