Individual
JESSIE LEA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 S JACKSON ST, MOSCOW, ID 83843-2038
(208) 582-3281
Mailing address
110 S JACKSON ST, MOSCOW, ID 83843-2038
(208) 582-3281
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/31/2020
Last updated
05/31/2020
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