Provider Demographics
NPI:1013178730
Name:DAHMS, JENNIFER (MS/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DAHMS
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 N COLE RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5964
Mailing Address - Country:US
Mailing Address - Phone:208-559-2348
Mailing Address - Fax:888-559-4660
Practice Address - Street 1:2995 N COLE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5964
Practice Address - Country:US
Practice Address - Phone:208-559-2348
Practice Address - Fax:888-559-4660
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1388235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist