Provider Demographics
NPI:1447463492
Name:COYLE, JANE ELIZABETH (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ELIZABETH
Last Name:COYLE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271M SIGNS RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3855
Mailing Address - Country:US
Mailing Address - Phone:718-494-1004
Mailing Address - Fax:
Practice Address - Street 1:3450 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6721
Practice Address - Country:US
Practice Address - Phone:718-448-7539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000893-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000893-1OtherPROFESSIONAL SLP LICENSE