| Organization Name: | BOISE SPEECH AND HEARING CLINIC |
| NPI Number: | 1104099589 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALESIA J. HITCHCOCK (SPEECH-LANGUAGE PATHOLOGIST) |
| Mailing Address: | 13176 W Persimmon Ln Suite 120 Boise |
| State: | ID US |
| Postal Code: | 837131986 |
| Phone Number: | 2083763591 |
| Fax Number: | 2083763591 |
| NPI Enumeration Date: | 04/08/2008 |
| NPI Last Update Date: | 04/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SLP-1320 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |