Individual
HEATHER PENSKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
1397 NORTH BIZTOWN LOOP, HAYDEN, ID 83835-5044
(208) 762-3502
Mailing address
1397 NORTH BIZTOWN LOOP, HAYDEN, ID 83835-5043
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1298
ID
Other
Enumeration date
03/27/2013
Last updated
03/27/2013
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