Individual
HEATHER DIEFENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSCCC-SLP
Contact information
Practice address
1351 W. PINE AVE, MERIDIAN, ID 83642
(208) 895-6431
Mailing address
2283 S. PETRA AVE, BOISE, ID 83709
(208) 830-6471
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1983
ID
Other
Enumeration date
11/26/2012
Last updated
11/26/2012
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