Individual
MARLA K AMBROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1812 N MIDLAND BLVD, NAMPA, ID 83651-1747
(208) 442-2525
(208) 442-2505
Mailing address
7052 S COLWOOD PL, BOISE, ID 83709-7373
(208) 412-9184
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1940
ID
235Z00000X
Speech-Language Pathologist
TSLP-1771
ID
Other
Enumeration date
11/13/2008
Last updated
06/01/2011
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