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General NPI Number Information
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NPI Number | 1326377607
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Entity Type | Individual
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Provider Name | JENNIFER ANNE SMOTHERMAN M.S.
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Gender | Female
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Dates
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Enumeration Date | 12/15/2009
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 800 KENSINGTON AVE SUITE 100
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City | MISSOULA
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State | MT
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Zip | 59801-5674
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Country | US
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Telephone | 406-274-0851
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Fax |
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Provider Business Mailing Address
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Address Line | 700 WOODWORTH AVE
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City | MISSOULA
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State | MT
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Zip | 59801-7049
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Country | US
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Telephone | 406-274-0851
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1189
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License Number State | MT
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