Provider Demographics
NPI:1538413208
Name:COE, JAMIE LOUISE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LOUISE
Last Name:COE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 N WESTERN AVE
Mailing Address - Street 2:#305
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-8039
Mailing Address - Country:US
Mailing Address - Phone:312-388-7876
Mailing Address - Fax:
Practice Address - Street 1:2911 N WESTERN AVE
Practice Address - Street 2:#305
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-8039
Practice Address - Country:US
Practice Address - Phone:312-388-7876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149010389101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool