Provider Demographics
NPI:1740585637
Name:COATS, JACKLYN (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JACKLYN
Middle Name:
Last Name:COATS
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 MAJESTIC DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-4347
Mailing Address - Country:US
Mailing Address - Phone:919-680-4907
Mailing Address - Fax:
Practice Address - Street 1:1807 MAJESTIC DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-4347
Practice Address - Country:US
Practice Address - Phone:919-680-4907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8865235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist