Individual
CARLY YATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(317) 385-8346
Mailing address
4667 W HIDDEN SPRINGS DR, BOISE, ID 83714-9352
(317) 385-8346
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
TSLP-5463
ID
Other
Enumeration date
07/31/2017
Last updated
08/30/2022
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