Individual
AMY JEWELL TOLLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16782 N BRAXTON AVE, NAMPA, ID 83687-8939
(208) 949-3853
Mailing address
16782 N BRAXTON AVE, NAMPA, ID 83687-8939
(208) 949-3853
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Enumeration date
10/23/2019
Last updated
10/23/2019
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