Individual
JENNIE REEVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
1619 CURLEW DR, AMMON, ID 83406-4719
(208) 535-1291
Mailing address
PO BOX 3629, IDAHO FALLS, ID 83403-3629
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1503
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12117838
ASHA CERTIFICATION NUMBER
—
01
—
SLP-1503
STATE LICENSE
ID
Enumeration date
12/11/2006
Last updated
07/08/2007
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