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Individual

BECKY HATHAWAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
353 N 4TH AVE, SUITE 110, POCATELLO, ID 83201-6390
(208) 233-7832
Mailing address
PO BOX 4908, POCATELLO, ID 83205-4908
(208) 236-1600

Taxonomy

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

Other

Enumeration date
05/02/2013
Last updated
05/02/2013
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