Provider Demographics
NPI:1447328901
Name:WILLER, JANENE A (MA, CCC-SLP)
Entity type:Individual
Prefix:PROF
First Name:JANENE
Middle Name:A
Last Name:WILLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 YALE ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3436
Mailing Address - Country:US
Mailing Address - Phone:208-282-3827
Mailing Address - Fax:208-282-4571
Practice Address - Street 1:IDAHO STATE UNIVERSITY 921 S 8TH AVE
Practice Address - Street 2:STOP 8116
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83209-0001
Practice Address - Country:US
Practice Address - Phone:208-282-3827
Practice Address - Fax:208-282-4571
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist