Individual
BEN L WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.S.
Contact information
Practice address
2871 AGNES ST, IDAHO FALLS, ID 83402-5639
(208) 270-2716
Mailing address
2871 AGNES ST, IDAHO FALLS, ID 83402-5639
(208) 270-2716
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
563139723
ID
Other
Enumeration date
08/02/2020
Last updated
08/02/2020
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