| NPI | 1184136798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EZEKIEL HANS KELSEY Speech Language Pathologist 208-320-5686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: ID SLP-1643) |
| Enumeration Date | 2017-11-04 |
| Last Update Date | 2017-11-04 |