Provider Demographics
NPI:1528191640
Name:SOLOAGA, LENI (MSCCCSLP)
Entity type:Individual
Prefix:
First Name:LENI
Middle Name:
Last Name:SOLOAGA
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12472 W NORRISTOWN ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-8123
Mailing Address - Country:US
Mailing Address - Phone:208-420-0109
Mailing Address - Fax:
Practice Address - Street 1:890 N COLE RD
Practice Address - Street 2:STE A
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8638
Practice Address - Country:US
Practice Address - Phone:208-323-8888
Practice Address - Fax:208-323-8889
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1546235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010157677OtherREGENCE BLUE SHIELD
12003265OtherASHA
IDSLP05OtherBLUE CROSS PROVIDER #