Individual
MRS. KIMBERLY ANN LAURIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
890 N COLE RD, SUITE A, BOISE, ID 83704-8638
(208) 323-8888
(208) 323-8889
Mailing address
8522 W FALLING STAR ST, BOISE, ID 83709-6367
(208) 362-4049
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP1419
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010148695
REGENCE BLUESHIELD OF ID
ID
01
—
12003294
ASHA
—
01
—
SP748
BLUE CROSS INSURANCE
ID
Enumeration date
12/27/2006
Last updated
07/08/2007
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