Individual
LAURA TAVENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3421 E 200 N, RIGBY, ID 83442-5401
(208) 709-3610
Mailing address
3421 E 200 N, RIGBY, ID 83442-5401
(208) 709-3610
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1499
ID
Other
Enumeration date
12/07/2016
Last updated
12/07/2016
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