Individual
STACEY CARROTHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 11TH AVE S STE 155, NAMPA, ID 83651-3918
(208) 466-1077
Mailing address
101 11TH AVE S STE 155, NAMPA, ID 83651-3918
(208) 466-1077
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
TSLP-4777
ID
Other
Enumeration date
06/10/2021
Last updated
06/10/2021
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