Individual
KAITLYNDAWN HAYNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
738 S BRIDGEWAY PL STE 150, EAGLE, ID 83616-6953
(888) 392-8642
Mailing address
646 GOSHAWK AVE, MIDDLETON, ID 83644-5977
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/01/2023
Last updated
11/01/2023
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