Provider Demographics
NPI:1497154348
Name:IMSAND CHUMBLEY, JILL JULIET (MS)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:JULIET
Last Name:IMSAND CHUMBLEY
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 1:612 E MAIN ST
Mailing Address - Street 2:#C
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3719
Mailing Address - Country:US
Mailing Address - Phone:406-522-3722
Mailing Address - Fax:
Practice Address - Street 1:612 E MAIN ST
Practice Address - Street 2:#C
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3719
Practice Address - Country:US
Practice Address - Phone:406-522-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-16
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-SP-TMP-4100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist