Healthcare Provider Details

I. General information

NPI: 1114843083
Provider Name (Legal Business Name): DELAYNIE DORSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DELAYNIE JUDY

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 KAI CT
AMMON ID
83406-5184
US

IV. Provider business mailing address

3040 KAI CT
AMMON ID
83406-5184
US

V. Phone/Fax

Practice location:
  • Phone: 208-989-8494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9971173
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: