| NPI | 1396806139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON MICHAEL GRAY Managing Member Owner 208-322-2844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-08-22 |