Individual
KEVIN KELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
859 S YELLOWSTONE HWY, REXBURG, ID 83440-5293
(208) 313-0091
Mailing address
335 GUSTAFSON DR, IDAHO FALLS, ID 83402-4637
(208) 313-0091
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8961468
ID
Other
Enumeration date
07/24/2024
Last updated
07/24/2024
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