Provider Demographics
NPI:1942744842
Name:LAPORTA, JAMIE M (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:LAPORTA
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 416501
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-3967
Mailing Address - Country:US
Mailing Address - Phone:866-448-9543
Mailing Address - Fax:
Practice Address - Street 1:10033 WICKER AVE STE 7&8
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-8776
Practice Address - Country:US
Practice Address - Phone:219-213-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46003087A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist