Organization
AGAVE SPEECH AND LANGUAGE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER HOBBS CCC-SLP (OWNER)
(208) 761-2109
Entity
Organization
Contact information
Practice address
1747 N FAIRMEADOW DR, BOISE, ID 83704-7007
(208) 761-2109
Mailing address
9504 W AMITY RD, BOISE, ID 83709-5311
(208) 761-2109
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-2638
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215360169
INDIVIDUAL NPI
ID
Enumeration date
03/28/2018
Last updated
03/28/2018
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