Individual
MISS ELLEN WANDLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2078
Mailing address
6715 W MORRIS HILL LN APT 104, BOISE, ID 83704-9286
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2834
ID
Other
Enumeration date
10/23/2015
Last updated
10/23/2015
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