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General NPI Number Information
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NPI Number | 1346360807
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Entity Type | Individual
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Provider Name | KIRSTEN M GRIDER MS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 1833 MILLENIUM WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-1510
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Country | US
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Telephone | 208-921-9314
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Fax | 208-323-2224
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Provider Business Mailing Address
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Address Line | 8404 W GALILEO CT
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City | BOISE
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State | ID
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Zip | 83709-7850
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Country | US
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Telephone | 208-921-9314
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Fax | 208-321-8557
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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 | SLP1413
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License Number State | ID
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