MEDICARE: KLADUKE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	12038998	ID

General Provider Information

NPI Number	:	1063671238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KLADUKE INC

Provider Business Mailing Address
First Line	:	PO BOX 611
Second Line	:
City	:	DRIGGS
State	:	ID
Zip	:	83422-0611
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 N 1ST ST
Second Line	:
City	:	DRIGGS
State	:	ID
Zip	:	83422-0000
Country	:	US
Telephone Number	:	208-354-5775
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	KAREN LADUKE
Credential	:
Telephone Number	:	208-716-2351

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	06/03/2008

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Directions to “KLADUKE INC ” Practice Location

Language	Start Address	Practice Location

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