Individual
DUSTIN ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
3402 FRANKLIN RD, CALDWELL, ID 83605-6932
(208) 459-0092
Mailing address
1524 EVERETT ST, CALDWELL, ID 83605-4245
(208) 936-9684
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/11/2016
Last updated
10/11/2016
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