person
Jacob Daniel Waller
Student in an Organized Health Care Education/Training Program in Moscow, Idaho
NPI 1295428191

Jacob Daniel Waller is a Student in an Organized Health Care Education/Training Program based in Nampa, ID. Jacob Daniel Waller practices in Moscow, ID. The NPI Number for Jacob Daniel Waller is 1295428191 and holds a License No. (Idaho).

The current practice location address for Jacob Daniel Waller is 875 Perimeter Dr, Moscow, ID and can be reached out via phone at 208-885-6111. You can also correspond with Jacob Daniel Waller through the mailing address at 11645 W CROSS SLOPE WAY, NAMPA, ID - 83686-5674 (mailing address contact number: 925-522-9815).

Location: 875 Perimeter Dr, Moscow, ID, 83686-5674
person
Provider Profile Details
NPI Number
1295428191
Provider Name
Jacob Daniel Waller
Credential
Provider Entity Type
Individual
Gender
Male
Address
875 Perimeter Dr, Moscow, ID, 83686-5674
Phone Number
208-885-6111
Fax Number
Provider Enumeration Date
05/29/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
875 Perimeter Dr
City
State
Zip
83844-9803
Phone Number
208-885-6111
Fax Number
person
Provider Business Mailing Address Details
Address
11645 W Cross Slope Way
City
State
Zip
83686-5674
Phone Number
925-522-9815
Fax Number
person
Provider's Taxonomy Details 1
Type
Speech, Language and Hearing Service Providers
Classification
Specialist/Technologist
Speciality
-
Taxonomy
License No.
()
Definition
General classification identifying individuals who are trained on a specific piece of equipment or technical procedure.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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