Individual
KRISTIN G BOOTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
405 W MYRTLE ST, BOISE, ID 83702-7658
(208) 972-2510
Mailing address
405 W MYRTLE ST, BOISE, ID 83702-7658
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-2765
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12099045
ASHA
—
01
—
SLP-2765
SLP
ID
Enumeration date
08/12/2015
Last updated
08/12/2015
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