Provider Demographics
NPI:1144667833
Name:ANDERSON, TRISHA M (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:TRISHA
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W GEORGIA AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-3024
Mailing Address - Country:US
Mailing Address - Phone:208-489-5700
Mailing Address - Fax:208-489-4077
Practice Address - Street 1:207 W GEORGIA AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-3024
Practice Address - Country:US
Practice Address - Phone:208-489-5700
Practice Address - Fax:208-489-4077
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist