Individual
SPENCER WENDELL OLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
205 SPRUCE ST, SHELLEY, ID 83274-1441
(208) 360-4294
Mailing address
205 SPRUCE ST, SHELLEY, ID 83274-1441
(208) 360-4294
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
—
Other
Enumeration date
10/13/2022
Last updated
10/13/2022
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