Provider Demographics
NPI:1306005111
Name:BOHM, JACLYN J (DPM)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:J
Last Name:BOHM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:J
Other - Last Name:SCHEVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15075 CIMARRON AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-1635
Mailing Address - Country:US
Mailing Address - Phone:651-322-8800
Mailing Address - Fax:651-322-8840
Practice Address - Street 1:15705 CIMARRON AVE
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068
Practice Address - Country:US
Practice Address - Phone:651-322-8800
Practice Address - Fax:651-322-8840
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN842213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery