Provider Demographics
NPI:1710232491
Name:GOICOECHEA, JAMIE JO (MS)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:JO
Last Name:GOICOECHEA
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 1:2300 S ORCHARD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-6722
Mailing Address - Country:US
Mailing Address - Phone:208-908-6469
Mailing Address - Fax:208-577-6700
Practice Address - Street 1:2300 S ORCHARD ST
Practice Address - Street 2:SUITE B
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-6722
Practice Address - Country:US
Practice Address - Phone:208-908-6469
Practice Address - Fax:208-577-6700
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDTSLP2265235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist