Individual
SEAN WALLASZEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1087 E PARK BLVD, BOISE, ID 83712
(208) 369-9168
Mailing address
1316 N 21ST ST, BOISE, ID 83702-2409
(208) 867-7828
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/20/2022
Last updated
04/20/2022
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