Provider Demographics
NPI:1053435313
Name:COLE, JAMIE RENEE (MS, SLP-CCC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:RENEE
Last Name:COLE
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15678 E BLACKWARD LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-8651
Mailing Address - Country:US
Mailing Address - Phone:618-242-4582
Mailing Address - Fax:618-242-4582
Practice Address - Street 1:15678 E BLACKWARD LN
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-8651
Practice Address - Country:US
Practice Address - Phone:618-242-4582
Practice Address - Fax:618-242-4582
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
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