Individual
MRS. DEBRA A NILSSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
2377 CORONADO ST, IDAHO FALLS, ID 83404-7440
(208) 535-1286
(208) 535-1291
Mailing address
3862 SHADOW MOUNTAIN TRL, IDAHO FALLS, ID 83404-8283
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1231
ID
Other
Enumeration date
07/05/2006
Last updated
07/10/2014
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