Provider Demographics
NPI:1134693328
Name:LAVALLO, JAIME LYN
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:LYN
Last Name:LAVALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-1940
Mailing Address - Country:US
Mailing Address - Phone:732-705-1582
Mailing Address - Fax:
Practice Address - Street 1:950 ROUTE 36
Practice Address - Street 2:SUITE 100A
Practice Address - City:LEONARDO
Practice Address - State:NJ
Practice Address - Zip Code:07737
Practice Address - Country:US
Practice Address - Phone:732-639-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-07-10
Deactivation Date:2019-06-21
Deactivation Code:
Reactivation Date:2019-07-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist