Individual
MADISON WILLHIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
875 PERIMETER DR, MOSCOW, ID 83844-9803
(208) 885-6111
Mailing address
6521 193RD AVE E, BONNEY LAKE, WA 98391-8847
(253) 324-9912
Taxonomy
Speciality
Code
Description
License number
State
225500000X
Respiratory/Developmental/Rehabilitative Specialist/Technologist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/14/2023
Last updated
08/17/2023
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