Provider Demographics
NPI:1366403222
Name:BOHNENKAMP, JANE KRISTINE (MA CCCA)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:KRISTINE
Last Name:BOHNENKAMP
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:KRISTINE
Other - Last Name:CRABTREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCA
Mailing Address - Street 1:536 BAKER DRIVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613
Mailing Address - Country:US
Mailing Address - Phone:319-277-3905
Mailing Address - Fax:
Practice Address - Street 1:834 W 4 STREET
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702
Practice Address - Country:US
Practice Address - Phone:319-230-4360
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00587231H00000X
IA00872237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0457788Medicaid
IA0457788Medicaid
IAI15320Medicare ID - Type Unspecified