Provider Demographics
NPI:1144439357
Name:CONFER, JACKIE MARIE (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:JACKIE
Middle Name:MARIE
Last Name:CONFER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 PARK RIDGE LN NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7037
Mailing Address - Country:US
Mailing Address - Phone:810-355-1727
Mailing Address - Fax:
Practice Address - Street 1:3317 PARK RIDGE LN NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7037
Practice Address - Country:US
Practice Address - Phone:810-355-1727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist