Individual
NICKCOLE MELANIE YOUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BI
Contact information
Practice address
5202 LUCKY AVE APT A2, CHUBBUCK, ID 83202-2395
(208) 380-2249
Mailing address
5202 LUCKY AVE APT A2, CHUBBUCK, ID 83202-2395
(208) 380-2249
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/10/2023
Last updated
02/10/2023
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