Individual
NAUTICA WAGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1835 N WILDWOOD ST, BOISE, ID 83713-5146
(877) 200-8152
Mailing address
4164 S FEDERAL WAY APT Q103, BOISE, ID 83716-5572
(850) 226-2127
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-6332
ID
Other
Enumeration date
03/25/2024
Last updated
03/25/2024
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