Individual
LYDIA BELLE REISSMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12553 W EXPLORER DR STE 190, BOISE, ID 83713-1612
(208) 972-5254
Mailing address
302 S CURTIS RD, BOISE, ID 83705-1017
(715) 297-9807
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NA
—
ID
Enumeration date
10/14/2020
Last updated
10/14/2020
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