Clark, Jennifer Ann

Clark, Jennifer Ann is an individual health care provider with primary practice located at 330 Warner Dr , Lewiston ID 83501-4441. She recently has only one registered license in Speech, Language and Hearing Service Providers / Audiologist, which is considered as her primary health care specialty. Clark, Jennifer Ann can be contacted via phone (208) 746-0193.

Contact Information

Primary practice address
330 Warner Dr Lewiston ID 83501-4441
Phone: (208) 746-0193
Fax: (208) 746-7074
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Audiologist 231H00000X AUD-1728 Idaho

Profile Details

NPI number 1053584292
LBN Legal business name Clark, Jennifer Ann
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 9th, 2008
Last updated Apr 28th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053584292 NPPES
Idaho Other AU022 BLUE CROSS OF ID
Idaho Other 000010170154 BLUE CROSS OF ID
Idaho MEDICAID 8560278 BLUE CROSS OF ID
Idaho MEDICAID 808195700 BLUE CROSS OF ID
Idaho Other 1580017 BLUE CROSS OF ID
Idaho Other P00678807 BLUE CROSS OF ID

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