WILLIAM BLAKE TANNER

POCATELLO, ID
NPI1659707529
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy235Z00000X Speech-Language Pathologist,
(Licence: ID  TSLP-2448)
Enumeration Date2013-09-23
Last Update Date2013-09-23
Business Address
-- WILLIAM BLAKE TANNER SLP
1110 CALL CREEK DR SUITE 4B
POCATELLO, ID 83201-3001
Phone number: 208-233-4660
Mailing Address
-- WILLIAM BLAKE TANNER SLP
1110 CALL CREEK DR SUITE 4B
POCATELLO, ID 83201-3001
Phone number: 208-233-4660
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