Jess Seymour Boeder, MS., CCC, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP-1138 Issued in ID

Practice address

13176 W Persimmon LN
Ste. 120
Boise, ID 83713-5063

Phone

(208) 376-3591

Fax

(208) 376-3594

NPI assigned

Jul 28, 2015

Last updated

Jul 28, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1438041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438041600000",
    "number": "1972988210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13176 W PERSIMMON LN",
            "address_2": "STE. 120",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837135063",
            "telephone_number": "208-376-3591",
            "fax_number": "208-376-3594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13176 W PERSIMMON LN",
            "address_2": "STE. 120",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837135063",
            "telephone_number": "208-376-3591",
            "fax_number": "208-376-3594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOEDER",
        "first_name": "JESS",
        "middle_name": "SEYMOUR",
        "credential": "MS., CCC, SLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-28",
        "last_updated": "2015-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ID",
            "license": "SLP-1138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Boise, ID
• Providers in Boise, ID by specialty
• Speech-Language Pathologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.