Individual
TRAE PERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S. CCC - SLP
Contact information
Practice address
2377 CORONADO ST, IDAHO FALLS, ID 83404-7440
(208) 535-1286
Mailing address
3069 DISNEY DR, IDAHO FALLS, ID 83404-7320
(208) 690-9821
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP - 2790
ID
Other
Enumeration date
08/27/2015
Last updated
08/27/2015
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