Provider Demographics
NPI:1508028945
Name:HARDER, PATRICIA L (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:HARDER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 N CRESTMONT DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2184
Mailing Address - Country:US
Mailing Address - Phone:208-898-0988
Mailing Address - Fax:
Practice Address - Street 1:1550 N CRESTMONT DR
Practice Address - Street 2:SUITE E
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2184
Practice Address - Country:US
Practice Address - Phone:208-898-0988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1732235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist