| NPI | 1831853928 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATELYN JEAN SULLIVAN-VANKEUREN Speech Language Pathologist 208-221-7375 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist |
| Enumeration Date | 2021-10-26 |
| Last Update Date | 2021-10-26 |