Provider Demographics
NPI:1255472239
Name:VOLLMER, NANCY LEE (MA)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LEE
Last Name:VOLLMER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2496 BLUE CANYON CT
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-3915
Mailing Address - Country:US
Mailing Address - Phone:208-523-5513
Mailing Address - Fax:
Practice Address - Street 1:1619 CURLEW DR
Practice Address - Street 2:SUITE 5
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-4719
Practice Address - Country:US
Practice Address - Phone:208-535-1286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1587235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist