Individual
KELLY O'LEARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
405 W MYRTLE ST, BOISE, ID 83702-7658
(208) 489-5880
Mailing address
405 W MYRTLE ST, BOISE, ID 83702-7658
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP2340
ID
Other
Enumeration date
10/03/2013
Last updated
10/03/2013
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