Individual
DUANE DALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
700 S MAIN ST, MOSCOW, ID 83843-3056
(208) 883-1522
Mailing address
345 MEADOWLARK LN, MOSCOW, ID 83843-7501
(208) 301-2433
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1276
ID
Other
Enumeration date
01/22/2018
Last updated
01/22/2018
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