Provider Demographics
NPI:1194942706
Name:SCHOFFER CLOSSON, JENNIFER KATHERINE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KATHERINE
Last Name:SCHOFFER CLOSSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7848 SUGAREE TRL
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-9449
Mailing Address - Country:US
Mailing Address - Phone:406-493-6515
Mailing Address - Fax:
Practice Address - Street 1:9885 OBRIEN CREEK RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-5881
Practice Address - Country:US
Practice Address - Phone:406-543-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT970235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0534973Medicaid
MT66247-0OtherBLUE CROSS BLUE SHIELD