Organization
MAKONA THERAPY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SELINA PUENTE (OFFICE MANAGER)
(208) 904-3500
Entity
Organization
Contact information
Practice address
113 MAIN STREET N, KIMBERLY, ID 83341
(208) 421-9659
(208) 904-3947
Mailing address
225 MAIN ST N UNIT 182, KIMBERLY, ID 83341-7008
(208) 904-3500
(208) 904-3947
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IDTPID015531
—
ID
Enumeration date
03/16/2021
Last updated
08/28/2025
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