Provider Demographics
NPI:1902811458
Name:EARING, JAIME (CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:
Last Name:EARING
Suffix:
Gender:F
Credentials:CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 W ARDEN LN
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-5659
Mailing Address - Country:US
Mailing Address - Phone:847-902-1898
Mailing Address - Fax:
Practice Address - Street 1:200 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060
Practice Address - Country:US
Practice Address - Phone:847-949-2720
Practice Address - Fax:847-566-0123
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006835235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist