Provider Demographics
NPI:1770954794
Name:STRONG, WILLIAM (MS CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:STRONG
Suffix:
Gender:M
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 1:3902 BROKEN ARROW RD
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-7840
Mailing Address - Country:US
Mailing Address - Phone:208-298-7670
Mailing Address - Fax:208-417-1790
Practice Address - Street 1:3902 BROKEN ARROW RD
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815
Practice Address - Country:US
Practice Address - Phone:208-298-7670
Practice Address - Fax:208-417-1790
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-3107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1720595796Medicaid