Waller, Jacob Daniel

Waller, Jacob Daniel is an individual health care provider with primary practice located at 875 Perimeter Dr , Moscow ID 83844-9803. He recently has 2 registered licenses in different health care specialties including Speech, Language and Hearing Service Providers / Specialist/Technologist, Student, Health Care / Student in an Organized Health Care Education/Training Program. Student, Health Care / Student in an Organized Health Care Education/Training Program is his primary health care specialty. Waller, Jacob Daniel can be contacted via phone (208) 885-6111.

Contact Information

Primary practice address
875 Perimeter Dr Moscow ID 83844-9803
Phone: (208) 885-6111
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Specialist/Technologist 235500000X
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X

Profile Details

NPI number 1295428191
LBN Legal business name Waller, Jacob Daniel
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date May 29th, 2023
Last updated May 29th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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