Provider Demographics
NPI:1669822672
Name:REYES, ADAM (AUD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 N SUMMERBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8749
Mailing Address - Country:US
Mailing Address - Phone:208-938-5823
Mailing Address - Fax:
Practice Address - Street 1:1209 N SUMMERBROOK AVE STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8750
Practice Address - Country:US
Practice Address - Phone:208-938-5823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2981231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist