Provider Demographics
NPI:1912490764
Name:IVEY COKER, JESSICA DAWN (AUD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:DAWN
Last Name:IVEY COKER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:DAWN
Other - Last Name:IVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:1691 BIENVILLE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3756
Mailing Address - Country:US
Mailing Address - Phone:318-990-5390
Mailing Address - Fax:318-990-5749
Practice Address - Street 1:1691 BIENVILLE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-990-5390
Practice Address - Fax:318-990-5749
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7481231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA$$$$$$$$$Medicaid