1740434646 NPI number — JAMIE LYNN RABIDEAU M.A., CCC-SLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740434646 NPI number — JAMIE LYNN RABIDEAU M.A., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RABIDEAU
Provider First Name:
JAMIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARRISON
Provider Other First Name:
JAMIE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740434646
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6806 ROUTE 22
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLATTSBURGH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12901-4914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-572-5206
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5572 ROUTE 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-594-7060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  018169 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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