Individual
FABIOLA KOPERBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
36 PROFESSIONAL PLZ STE 110, REXBURG, ID 83440-2049
(208) 734-3356
Mailing address
36 PROFESSIONAL PLZ STE 110, REXBURG, ID 83440-2049
(208) 359-9570
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-4727
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SLP-4727
STATE LICENSE
ID
Enumeration date
05/20/2022
Last updated
05/20/2022
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