Individual
AUSTINN ELISE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
220 W GEORGIA AVE, NAMPA, ID 83686-2835
(425) 977-0088
Mailing address
90 SE DALO DR, MOUNTAIN HOME, ID 83647-6024
(208) 794-1807
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Enumeration date
06/02/2023
Last updated
06/02/2023
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