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General NPI Number Information
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NPI Number | 1801687074
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Entity Type | Individual
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Provider Name | JESSICA BOHM
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Gender | Female
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 4455 24TH AVE STE 150
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City | FORT GRATIOT
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State | MI
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Zip | 48059-4516
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Country | US
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Telephone | 248-232-0905
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Fax |
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Provider Business Mailing Address
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Address Line | 3453 SAINT CLAIR SHORES BLVD
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City | EAST CHINA
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State | MI
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Zip | 48054-1578
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Country | US
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Telephone | 810-990-4453
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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 |
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License Number State |
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