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General NPI Number Information
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NPI Number | 1023783768
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Entity Type | Individual
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Provider Name | HEATHER TANNER ANTHON
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Gender | Female
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Dates
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Enumeration Date | 08/13/2021
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 1501 HILAND AVE
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City | BURLEY
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State | ID
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Zip | 83318-2688
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Country | US
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Telephone | 208-677-6530
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Fax |
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Provider Business Mailing Address
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Address Line | 273 S 650 E
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City | BURLEY
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State | ID
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Zip | 83318-5653
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Country | US
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Telephone | 208-921-8188
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | TSLP-4826
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License Number State | ID
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