Individual
JEFF THALDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
904 N IMPERIAL WAY, BOISE, ID 83704-9033
(208) 841-5707
Mailing address
904 N IMPERIAL WAY, BOISE, ID 83704-9033
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
ID
Other
Enumeration date
10/29/2025
Last updated
10/29/2025
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