Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jacob Daniel Waller

Individual provider Speech/Language/Hearing Specialist/Technologist · NPI 1295428191

Jacob Daniel Waller is a Speech/Language/Hearing Specialist/Technologist in Moscow, Idaho. Registered with an NPI since 2023.

In the registry since
2023
Specialties on file
2

Practice location Address checks out

875 Perimeter Dr
Moscow, ID 83844-9803
Phone: (208) 885-6111
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X
Speech/Language/Hearing Specialist/Technologist Taxonomy 235500000X

Record details

NPI number1295428191
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMay 29, 2023
Last updated in NPPESMay 29, 2023
Certification dateMay 28, 2023
Mailing address11645 W Cross Slope Way, Nampa, ID 83686-5674

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