Individual
MS. JACIE JEAN POLLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
1110 CALL CREEK DR, SUITE #7, POCATELLO, ID 83201-3072
(208) 233-4660
(208) 233-4262
Mailing address
1333 N MAIN ST, POCATELLO, ID 83204-2609
(208) 269-0480
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1749
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12130374
ASHA CERTIFICATION #
—
01
—
SLP-1749
STATE LICENSE #
ID
Enumeration date
07/15/2008
Last updated
07/15/2008
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