Individual
JILL M BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 364-3300
(701) 364-8906
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-3300
(701) 364-8906
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1311
ND
235Z00000X
Speech-Language Pathologist
665
ND
235Z00000X
Speech-Language Pathologist
SLP8027
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1782578
AMERICA'S PPO/ARAZ #
ND
01
—
20605
NDBS #
ND
01
—
43G40BO
MNBS #
ND
01
—
4600421
MEDICA #
ND
01
—
4600456
MEDICA #
ND
05
—
52524
—
ND
01
—
ND200229
LHS #
ND
01
—
SLP8027
AZ LICENSE
AZ
Enumeration date
07/06/2006
Last updated
02/07/2014
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