Provider Demographics
NPI:1104416288
Name:IDAHO SPEECH & SWALLOW SERVICES
Entity type:Organization
Organization Name:IDAHO SPEECH & SWALLOW SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CAMARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:619-228-6060
Mailing Address - Street 1:4696 W OVERLAND RD STE 232
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:208-996-0828
Mailing Address - Fax:
Practice Address - Street 1:4696 W OVERLAND RD STE 232
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:208-996-0828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty