Provider Demographics
NPI:1548533771
Name:SPORLEDER-COULTER, JEAN A (MA)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:SPORLEDER-COULTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2847 ASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-5902
Mailing Address - Country:US
Mailing Address - Phone:626-372-3868
Mailing Address - Fax:626-529-5495
Practice Address - Street 1:2847 ASHLEY DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-5902
Practice Address - Country:US
Practice Address - Phone:626-372-3868
Practice Address - Fax:626-529-5495
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-19
Last Update Date:2012-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP6938235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist