Individual
HAILEY ALLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED
Contact information
Practice address
134 E HAZEL ST, GENESEE, ID 83832-8701
(208) 901-0618
Mailing address
134 E HAZEL ST, GENESEE, ID 83832-8701
(208) 901-0618
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
04/27/2023
Last updated
08/30/2024
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