Individual
JACQUELYN CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
240 W BURNSIDE AVE STE D, CHUBBUCK, ID 83202-4703
(208) 904-1112
Mailing address
240 W BURNSIDE AVE STE D, CHUBBUCK, ID 83202-4703
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5071179
ID
Other
Enumeration date
01/09/2026
Last updated
01/09/2026
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