Provider Demographics
NPI:1619606167
Name:RAINES, JOLEE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:JOLEE
Middle Name:
Last Name:RAINES
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 PEGASUS CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-8327
Mailing Address - Country:US
Mailing Address - Phone:443-776-0271
Mailing Address - Fax:301-663-8322
Practice Address - Street 1:5104 PEGASUS CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8327
Practice Address - Country:US
Practice Address - Phone:443-776-0271
Practice Address - Fax:301-663-8322
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02489L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist