Individual
MRS. MILODIE MAE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP-CCC
Contact information
Practice address
901 N CURTIS RD, STE. 204, BOISE, ID 83706-1338
(208) 367-7598
Mailing address
901 N CURTIS RD, STE. 204, BOISE, ID 83706-1338
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
15248
OR
235Z00000X
Speech-Language Pathologist
SLP-2909
ID
Other
Enumeration date
05/13/2016
Last updated
05/13/2016
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