Provider Demographics
NPI:1720639446
Name:KROEGER, AMBER LAYNE (MS CF SLP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LAYNE
Last Name:KROEGER
Suffix:
Gender:F
Credentials:MS CF SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 W EMERALD ST STE 150
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4841
Mailing Address - Country:US
Mailing Address - Phone:208-793-7006
Mailing Address - Fax:
Practice Address - Street 1:8601 W EMERALD ST STE 150
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4841
Practice Address - Country:US
Practice Address - Phone:208-793-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-4667235Z00000X
OR016670235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist