MEDICARE: MS. JENNIFER ANNE SMOTHERMAN M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	1189	MT

General Provider Information

NPI Number	:	1326377607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER ANNE SMOTHERMAN M.S.

Provider Business Mailing Address
First Line	:	700 WOODWORTH AVE
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-7049
Country	:	US
Telephone Number	:	406-274-0851
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 KENSINGTON AVE
Second Line	:	SUITE 100
City	:	MISSOULA
State	:	MT
Zip	:	59801-5674
Country	:	US
Telephone Number	:	406-274-0851
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2009
Last Update Date	:	12/30/2014

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