Individual
AMANDA ELAINE TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1460 ELK CREEK DR, IDAHO FALLS, ID 83404-8237
(208) 521-1622
Mailing address
2566 MARS ST, IDAHO FALLS, ID 83402-2302
(208) 521-1622
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
TSLP-4302
ID
Other
Enumeration date
06/16/2020
Last updated
06/16/2020
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