Provider Demographics
NPI:1508028929
Name:BRUNSON, JASMINE BROOKE (MS, CFY-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:BROOKE
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N LINCOLN AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-2300
Mailing Address - Country:US
Mailing Address - Phone:208-324-2443
Mailing Address - Fax:
Practice Address - Street 1:414 N LINCOLN AVE STE 5
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-2300
Practice Address - Country:US
Practice Address - Phone:208-324-2443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist