Individual
AMANDA TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1071 RENEE AVE, POCATELLO, ID 83201-2508
(208) 233-1411
Mailing address
1071 RENEE AVE, POCATELLO, ID 83201-2508
(208) 233-1411
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
TSLP-2914
ID
Other
Enumeration date
12/31/2016
Last updated
12/31/2016
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