NPI age
17 years
Enumerated 2008-07-15
Across 1046 active speech-language pathologist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | SLP-1749 | STATE LICENSE # |
| 01 | 12130374 | ASHA CERTIFICATION # |
Part of a multi-provider practice. 10 other active providers share this practice address in NPPES.
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