Individual
SHANNON RENEE WELCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19802 WILDERNESS DR, CALDWELL, ID 83605-8078
(208) 922-8348
Mailing address
19476 LORI DR, CALDWELL, ID 83607-9526
(208) 922-8348
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/22/2019
Last updated
07/22/2019
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