Provider Demographics
NPI:1073037073
Name:THURMAN, JACKIE ANN (MS)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:ANN
Last Name:THURMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25214 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GRAND VIEW
Mailing Address - State:ID
Mailing Address - Zip Code:83624-5002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:113 E AVENUE F
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-3132
Practice Address - Country:US
Practice Address - Phone:208-324-2443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist