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General NPI Number Information
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NPI Number | 1447309224
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Entity Type | Individual
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Provider Name | BECKY A. PIERCE M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1110 CALL CREEK DR STE 7
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City | POCATELLO
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State | ID
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Zip | 83201-3072
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Country | US
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Telephone | 208-233-4660
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Fax | 208-233-4262
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Provider Business Mailing Address
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Address Line | 2461 HAROLD DR
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3833
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Country | US
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Telephone | 208-520-8991
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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 | SLP-1359
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License Number State | ID
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