| NPI | 1497188387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARISSA LYNNE PETERSON Speech Language Pathologist 208-757-8553 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2013-08-14 |