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NPI 1104343078ActiveIndividual· Speech-Language Pathologist· Boise, ID

Speech-Language Pathologist in Boise, Idaho, licensed in ID, with an NPI issued in August 2017. Enrolled in Medicare as practitioner - qualified speech language pathologist.

Overview

NPI1104343078
StatusActive
Entity typeIndividual
Sole proprietorNo
NPI issuedAug 23, 2017
Last updated in NPPESDec 5, 2024
Certified by providerDec 5, 2024

Specialties and licenses

TaxonomyCodeLicenseState
Speech-Language Pathologist Primary235Z00000XSLP-4296ID

About license numbers in NPPES

Exclusion screening

ListResultDetails
HHS-OIG LEIE · Nov 10, 2026No matchChecked by NPI and by name + state
North Carolina Medicaid · Nov 11, 2026No match—
New York OMIG · Nov 11, 2026No match—
Ohio Medicaid · Nov 11, 2026No match—
Pennsylvania Medicheck · Nov 11, 2026No match—
Washington HCA · Nov 11, 2026No match—

Official OIG search · How matching works ·Bulk check a roster

Medicare

Enrollment (PECOS)Enrolled Practitioner - Qualified Speech Language Pathologist (ID)

Medicare sources and data years

Other Speech-Language Pathologist providers in Boise

All Speech-Language Pathologist providers in Idaho →