MEDICARE: BRITTANY HELEN DUNNUM

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	TSLP-5375	ID

General Provider Information

NPI Number	:	1942841796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY HELEN DUNNUM

Provider Business Mailing Address
First Line	:	1721 W IDAHO ST APT 216
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-5274
Country	:	US
Telephone Number	:	608-632-5045
Fax Number	:

Provider Business Practice Location Address
First Line	:	1409 W MAIN ST STE 120
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-5215
Country	:	US
Telephone Number	:	208-938-4748
Fax Number	:

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

Provider Enumeration Date	:	10/02/2019
Last Update Date	:	05/25/2023

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Directions to “ BRITTANY HELEN DUNNUM ” Practice Location

Language	Start Address	Practice Location

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