Organization
CALICO PEDIATRIC THERAPY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTIN K NEGILSKI MS CCC-SLP (OWNER)
(208) 850-5804
Entity
Organization
Contact information
Practice address
1650 N HILTON ST, BOISE, ID 83706-1734
(208) 850-5804
Mailing address
4145 WILLOW CREEK RD, EAGLE, ID 83616-2505
(208) 850-5804
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1396
ID
Other
Enumeration date
11/01/2011
Last updated
11/01/2011
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