Individual
MISS M. LONNETTE LUPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
113 E AVENUE F, JEROME, ID 83338-3132
(208) 324-2443
Mailing address
743 19TH AVE E, JEROME, ID 83338-1520
(208) 644-6468
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1488
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808103700
—
ID
01
—
SP054
BLUE CROSS OF IDAHO
ID
Enumeration date
06/03/2008
Last updated
09/23/2008
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