Individual
KELLI SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3115 N SYCAMORE DR, BOISE, ID 83703-4129
(208) 401-6401
Mailing address
613 N HILLVIEW DR, BOISE, ID 83712-8120
(208) 353-7776
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
TSLP-2657
ID
Other
Enumeration date
03/18/2015
Last updated
03/18/2015
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