Individual
AMANDA DYKSTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
9209 W WAKEFIELD ST, BOISE, ID 83714-6708
(714) 501-0557
Mailing address
9209 W WAKEFIELD ST, BOISE, ID 83714-6708
(714) 501-0557
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
00003878
CA
235Z00000X
Speech-Language Pathologist
2025
ND
235Z00000X
Speech-Language Pathologist
5014
ID
Other
Enumeration date
10/05/2022
Last updated
10/05/2022
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