Individual
KAITYLN SHEPHERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4232 N WATERFORD PL, BOISE, ID 83703-3490
(312) 965-2997
Mailing address
4232 N WATERFORD PL, BOISE, ID 83703-3490
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/23/2021
Last updated
04/23/2021
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