Individual
KETHA MEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1350 TROY RD, SUITE 2, MOSCOW, ID 83843-3995
(208) 882-6912
(208) 882-8575
Mailing address
1350 TROY RD, SUITE 2, MOSCOW, ID 83843-3995
(208) 882-6912
(208) 882-8575
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
02/29/2016
Last updated
02/29/2016
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