Provider Demographics
NPI:1316118466
Name:ELCOX, JACQUIE ANNE (BC- HIS)
Entity type:Individual
Prefix:
First Name:JACQUIE
Middle Name:ANNE
Last Name:ELCOX
Suffix:
Gender:F
Credentials:BC- HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 N COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8642
Mailing Address - Country:US
Mailing Address - Phone:208-377-0019
Mailing Address - Fax:208-377-0313
Practice Address - Street 1:1084 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8642
Practice Address - Country:US
Practice Address - Phone:208-377-0019
Practice Address - Fax:208-377-0313
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA-187237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDHA-187OtherIDAHO HEARING AID DEALER