Healthcare Provider Details

I. General information

NPI: 1669387015
Provider Name (Legal Business Name): MORGAN ANNE JENSON TUELLER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3086 W MILANO DR
MERIDIAN ID
83646-7288
US

IV. Provider business mailing address

1059 W PINE AVE APT 3
MERIDIAN ID
83642-8324
US

V. Phone/Fax

Practice location:
  • Phone: 208-996-0552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9781028
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: