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Individual

WILLIAM BLAKE TANNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
SLP

Contact information

Practice address
1110 CALL CREEK DR, SUITE 4B, POCATELLO, ID 83201-3001
(208) 233-4660
(208) 233-4262
Mailing address
1110 CALL CREEK DR, SUITE 4B, POCATELLO, ID 83201-3001
(208) 233-4660
(208) 233-4262

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
TSLP-2448
ID

Other

Enumeration date
09/23/2013
Last updated
09/23/2013
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