Individual
MRS. CARLEN WILLIAMS HERVIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
73 NORTH MAIN STREET, VICTOR, ID 83455
(208) 705-7868
Mailing address
PO BOX 449, DRIGGS, ID 83422-0449
(208) 709-7868
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1112
ID
Other
Enumeration date
06/03/2014
Last updated
06/03/2014
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