Provider Demographics
NPI:1740434646
Name:RABIDEAU, JAMIE LYNN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:RABIDEAU
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:6806 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-4914
Mailing Address - Country:US
Mailing Address - Phone:518-572-5206
Mailing Address - Fax:
Practice Address - Street 1:5572 ROUTE 11
Practice Address - Street 2:
Practice Address - City:ELLENBURG
Practice Address - State:NY
Practice Address - Zip Code:12933
Practice Address - Country:US
Practice Address - Phone:518-594-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist