Individual
STEPHANIE COULTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSS
Contact information
Practice address
2200 W FAIRVIEW AVE, BOISE, ID 83702-6808
(208) 344-3512
(208) 467-3391
Mailing address
PO BOX 9, NAMPA, ID 83653-0009
(208) 467-4431
(208) 466-5359
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
ID
Other
Enumeration date
09/12/2019
Last updated
09/12/2019
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