Individual
KEELEY COFFEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
625 POLE LINE RD W STE 2B, TWIN FALLS, ID 83301-4270
(208) 814-7350
(208) 732-8508
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AUD-6429
ID
Other
Enumeration date
06/18/2024
Last updated
07/23/2024
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