Individual
MRS. CORRENE FABANICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
36 PROFESSIONAL PLZ STE 110, REXBURG, ID 83440-2049
(208) 359-9570
(208) 359-9580
Mailing address
36 PROFESSIONAL PLZ STE 110, REXBURG, ID 83440-2049
(208) 359-9570
(208) 359-9580
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
TSLP-3260
ID
Other
Enumeration date
08/16/2017
Last updated
08/16/2017
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