Individual
RANDALL BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1720 18TH AVE, LEWISTON, ID 83501-4047
(208) 746-4097
(208) 746-2294
Mailing address
1720 18TH AVE, LEWISTON, ID 83501-4047
(208) 746-4097
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/28/2024
Last updated
10/28/2024
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