Individual
MRS. KATIE DONALDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2062 N LARK PL, MERIDIAN, ID 83646-3326
(208) 316-9313
Mailing address
2062 N LARK PL, MERIDIAN, ID 83646-3326
(208) 316-9313
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106S00000X
—
ID
05
—
1417685967
—
ID
Enumeration date
08/11/2022
Last updated
09/14/2022
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