Individual
MADYSEN LAURA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
2222 TETON PLZ STE 2, IDAHO FALLS, ID 83404-6485
(208) 522-4026
Mailing address
2222 TETON PLZ STE 2, IDAHO FALLS, ID 83404-6485
(208) 522-4026
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-170481
IL
Other
Enumeration date
11/08/2022
Last updated
11/08/2022
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