NPI age
10 years
Enumerated 2015-08-12
Across 1046 active speech-language pathologist providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1366818494 | |
| 01 (WY) | SP-873 | STATE LICENSE |
| 01 | 14082738 | NATIONAL CERTIFICATION |
| 01 (ID) | SLP-3036 | STATE LICENSE |
Solo or small practice. No other active providers share this practice address in NPPES.
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