Provider Demographics
NPI:1760986525
Name:COATES, JAIMEE LYNN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAIMEE
Middle Name:LYNN
Last Name:COATES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 SUSSEX LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1815
Mailing Address - Country:US
Mailing Address - Phone:267-934-0310
Mailing Address - Fax:
Practice Address - Street 1:3641 SUSSEX LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1815
Practice Address - Country:US
Practice Address - Phone:267-934-0310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013448235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist