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Individual

KATHERINE MCENTEE MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MED CCC-SLP

Contact information

Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2078
Mailing address
PO BOX 9495, BOISE, ID 83707-3495

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-3554
ID

Other

Enumeration date
08/23/2018
Last updated
08/23/2018
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