Individual
DANIELLE MARIE WALLNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
77 N FISHER PARK WAY, EAGLE, ID 83616-4796
(208) 378-5430
Mailing address
2965 E TARPON DR STE 150, MERIDIAN, ID 83642-9007
(208) 287-9420
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1131
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225239783
—
ID
Enumeration date
05/30/2007
Last updated
04/24/2018
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