Provider Demographics
NPI:1356965941
Name:IDAHO FACE & VOICE, LLC
Entity type:Organization
Organization Name:IDAHO FACE & VOICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:208-500-1728
Mailing Address - Street 1:4696 W OVERLAND RD STE 228
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2864
Mailing Address - Country:US
Mailing Address - Phone:208-500-1728
Mailing Address - Fax:208-908-0501
Practice Address - Street 1:4696 W OVERLAND RD STE 228
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2864
Practice Address - Country:US
Practice Address - Phone:208-500-1728
Practice Address - Fax:208-908-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-30
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDIDTPID015350Medicaid