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NPI Code Detail

MEDICARE: MICHELLE DAHLBERG CCC-SLP

MEDICARE:   MICHELLE  DAHLBERG  CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistSLP-1147ID

General Provider Information

NPI Number : 1255353488
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE DAHLBERG CCC-SLP
Provider Business Mailing Address
First Line : 1225 S HIGHLINE DR
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83401-5909
Country : US
Telephone Number : 208-604-1286
Fax Number : 208-535-1291
Provider Business Practice Location Address
First Line : 1460 ELK CREEK DR
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83404-8237
Country : US
Telephone Number : 208-535-1286
Fax Number : 208-535-1291
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2006
Last Update Date : 03/09/2022

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Directions to “ MICHELLE DAHLBERG CCC-SLP” Practice Location

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