Individual
MISS SHANNON MARIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
1001 N 7TH AVE STE 280, POCATELLO, ID 83201-5788
(208) 239-1490
(208) 239-1794
Mailing address
1559 STEVENS DRIVE, UNIT D, IDAHO FALLS, ID 83401
(208) 241-3486
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-2557
ID
Other
Enumeration date
07/21/2014
Last updated
09/19/2024
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