Individual
MRS. TARA T BURRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S, CCC-SLP
Contact information
Practice address
1110 CALL CREEK DR STE 7, POCATELLO, ID 83201-3072
(208) 233-4660
(208) 233-4262
Mailing address
1110 CALL CREEK DR STE 7, POCATELLO, ID 83201-3072
(208) 233-4660
(208) 233-4262
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1741
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12118744
AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
ID
01
—
1741
IDAHO SPEECH AND HEARING SERVICES BOARD
ID
Enumeration date
06/25/2008
Last updated
06/25/2008
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