MEDICARE: JAIMEE LYNN COATES CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SL013448	PA

General Provider Information

NPI Number	:	1760986525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIMEE LYNN COATES CCC-SLP

Provider Business Mailing Address
First Line	:	3641 SUSSEX LN
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1815
Country	:	US
Telephone Number	:	267-934-0310
Fax Number	:

Provider Business Practice Location Address
First Line	:	3641 SUSSEX LN
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1815
Country	:	US
Telephone Number	:	267-934-0310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2018
Last Update Date	:	03/19/2018

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