Healthcare Provider Details

I. General information

NPI: 1033696323
Provider Name (Legal Business Name): CHARLYN KAY REECE MS SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARY REECE

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 3RD AVE S
PAYETTE ID
83661-2832
US

IV. Provider business mailing address

89 ORD BLVD
NAMPA ID
83651-2065
US

V. Phone/Fax

Practice location:
  • Phone: 208-642-4455
  • Fax:
Mailing address:
  • Phone: 208-473-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP-3009
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: