=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750429767
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANNE MARIE GILMORE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1453 NO. MAIN ST.
-----------------------------------------------------
City | SAN LUIS
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85349-7986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-627-6985
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2211 W TONTO RIDGE RD
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86305-3939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-445-4605
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YS0200X
-----------------------------------------------------
Taxonomy Name | School Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------