Provider Demographics
NPI:1033696323
Name:REECE, CHARLYN KAY (MS SLP-CCC)
Entity Type:Individual
Prefix:
First Name:CHARLYN
Middle Name:KAY
Last Name:REECE
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:CHARY
Other - Middle Name:
Other - Last Name:REECE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:89 ORD BLVD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-2065
Mailing Address - Country:US
Mailing Address - Phone:208-473-6551
Mailing Address - Fax:
Practice Address - Street 1:1019 3RD AVE S
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-2832
Practice Address - Country:US
Practice Address - Phone:208-642-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-3009235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist