Individual
CODY ALLEN BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
495 N SHILLING AVE APT 1, BLACKFOOT, ID 83221-2336
(208) 643-4433
Mailing address
385 GOLDEN ST APT 1, BLACKFOOT, ID 83221-2775
(208) 646-0165
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
ID
Other
Enumeration date
04/16/2026
Last updated
04/16/2026
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