Provider Demographics
NPI:1770629271
Name:COATS, ISABEL ANGELA (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:ANGELA
Last Name:COATS
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 TORREY PINES RD
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-5709
Mailing Address - Country:US
Mailing Address - Phone:309-838-9397
Mailing Address - Fax:309-452-4045
Practice Address - Street 1:1526 TORREY PINES RD
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-5709
Practice Address - Country:US
Practice Address - Phone:309-838-9397
Practice Address - Fax:309-452-4045
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05732062OtherBLUE CROSS BLUE SHIELD