Individual
KATELON FRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
738 S BRIDGEWAY PL STE 150, EAGLE, ID 83616-6953
(888) 392-8642
Mailing address
2413 KENTUCKY PL, NAMPA, ID 83686-6289
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/14/2024
Last updated
05/14/2024
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