DYLAN WAKE

IDAHO FALLS, ID
NPI1215401963
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy235Z00000X Speech-Language Pathologist,
(Licence: ID  SLP-3589)
Enumeration Date2019-01-16
Last Update Date2019-01-16
Business Address
DYLAN WAKE M.S. CCC-SLP
3100 CHANNING WAY
IDAHO FALLS, ID 83404-7533
Phone number: 208-529-7685
Mailing Address
DYLAN WAKE M.S. CCC-SLP
3100 CHANNING WAY
IDAHO FALLS, ID 83404-7533
Phone number: 208-529-7685
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