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NPI Code Detail

MEDICARE: JACKIE ANN THURMAN MS

MEDICARE:   JACKIE ANN THURMAN  MS
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
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1073037073
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKIE ANN THURMAN MS
Provider Business Mailing Address
First Line : 25214 RIVER RD
Second Line :
City : GRAND VIEW
State : ID
Zip : 83624-5002
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 113 E AVENUE F
Second Line :
City : JEROME
State : ID
Zip : 83338-3132
Country : US
Telephone Number : 208-324-2443
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2017
Last Update Date : 08/01/2017

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Directions to “ JACKIE ANN THURMAN MS” Practice Location

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