Individual
JESSICA ASHLEY ISOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
230 W 15TH ST, IDAHO FALLS, ID 83402-4238
(208) 351-0486
Mailing address
230 W 15TH ST, IDAHO FALLS, ID 83402-4238
(208) 351-0486
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
XA174526J
ID
Other
Enumeration date
06/03/2022
Last updated
06/03/2022
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