Individual
KENDRA VAWN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1800 N COLE RD APT G304, BOISE, ID 83704-1304
(831) 578-3133
Mailing address
1800 N COLE RD APT G304, BOISE, ID 83704-1304
(831) 578-3133
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/23/2022
Last updated
11/25/2022
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