Individual
CRAIG MOULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
420 CARDINAL DR, SHELLEY, ID 83274-4925
(208) 243-4331
Mailing address
420 CARDINAL DR, SHELLEY, ID 83274-4925
(208) 243-4331
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/01/2021
Last updated
01/01/2021
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