Provider Demographics
NPI:1346360807
Name:GRIDER, KIRSTEN M (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:M
Last Name:GRIDER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8404 W GALILEO CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-7850
Mailing Address - Country:US
Mailing Address - Phone:208-921-9314
Mailing Address - Fax:208-321-8557
Practice Address - Street 1:1833 MILLENIUM WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1510
Practice Address - Country:US
Practice Address - Phone:208-921-9314
Practice Address - Fax:208-323-2224
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP1413235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist