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Organization
IDAHO STATE UNIVERSITY
Active
Organization
IDAHO STATE UNIVERSITY
Active
Other names
Idaho State University Speech & Hearing Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA L ROCK (CLINICS DIRECTOR OF OPERATIONS)
(208) 373-1743
Entity
Organization
Contact information
Practice address
650 MEMORIAL DRIVE, BLDG #68, POCATELLO, ID 83201
(208) 282-3495
(208) 282-4571
Mailing address
921 S 8TH AVE STOP 8116, POCATELLO, ID 83209-0002
(208) 282-3495
(208) 282-4571
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
11/17/2006
Last updated
02/27/2024
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