Individual
WAYNE KAUPPILA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC
Contact information
Practice address
605 11TH AVE E, GOODING, ID 83330-5368
(208) 934-8461
(208) 934-5437
Mailing address
605 11TH AVE E, GOODING, ID 83330-5368
(208) 934-8461
(208) 934-5437
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
170
ID
Other
Enumeration date
08/18/2011
Last updated
08/18/2011
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