Individual
GRACIE ANN MINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
220 W GEORGIA AVE, NAMPA, ID 83686-2835
(425) 368-3262
Mailing address
12408 BISCAY ST, CALDWELL, ID 83607-5844
(208) 308-9625
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/26/2023
Last updated
01/26/2023
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