Basic Information
| Provider Information | |||||||||
| NPI: | 1669822672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYES | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | |||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1209 N SUMMERBROOK AVE | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836428749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089385823 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1209 N SUMMERBROOK AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836428750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089385823 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2016 | ||||||||
| LastUpdateDate: | 05/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 2981 | ID | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.