Individual
MS. GRACE KALISKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC SLP
Contact information
Practice address
12124 W FERAMORZ LN, STAR, ID 83669-5165
(208) 391-2773
(855) 255-0774
Mailing address
12124 W FERAMORZ LN, STAR, ID 83669-5165
(208) 391-2773
(855) 255-0774
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1678
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
ID
Enumeration date
03/10/2017
Last updated
03/10/2017
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