Individual
ANNA NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
320 11TH AVE S, NAMPA, ID 83651-5073
(208) 466-1077
(208) 467-2201
Mailing address
320 11TH AVE S, NAMPA, ID 83651-5073
(208) 466-1077
(208) 467-2201
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
TSLP-2569
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447427349
—
ID
Enumeration date
11/04/2014
Last updated
11/04/2014
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