Organization
ST. LUKE'S CHILDREN'S
Active
Parent organization
ST. LUKE'S
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. LUKE'S
Authorized official
KRISTIN G BOOTON MS CCC-SLP (SPEECH LANGUAGE PATHOLOGIST)
(502) 693-0329
Entity
Organization
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2804
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
282NC2000X
Children's Hospital
Primary
SLP-2765
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12099045
ASHA
—
01
—
SLP-2765
IDAHO SPEECH AND HEARING ASSOCIATION
ID
Enumeration date
07/19/2015
Last updated
07/19/2015
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