Provider Demographics
NPI:1447268602
Name:MCCLURE, JONNI ANNE (MA)
Entity type:Individual
Prefix:MRS
First Name:JONNI
Middle Name:ANNE
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-3865
Mailing Address - Country:US
Mailing Address - Phone:505-544-4041
Mailing Address - Fax:505-546-7210
Practice Address - Street 1:800 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-3865
Practice Address - Country:US
Practice Address - Phone:505-544-4041
Practice Address - Fax:505-546-7210
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM486237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10116Medicaid