Provider Demographics
NPI:1326731803
Name:GINTER, JACQUELYN (BSRT)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:
Last Name:GINTER
Suffix:
Gender:F
Credentials:BSRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 E EFFRA ST
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-7611
Mailing Address - Country:US
Mailing Address - Phone:661-437-0499
Mailing Address - Fax:
Practice Address - Street 1:5709 E EFFRA ST
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-7611
Practice Address - Country:US
Practice Address - Phone:661-437-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLRT-2262174H00000X, 2083P0901X, 171M00000X, 227900000X, 2279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care
No174H00000XOther Service ProvidersHealth Educator
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered