Organization
ST. MARIES SCHOOL DISTRICT #41
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY GUIDRY (MEDICAID BILLING)
(208) 245-2142
Entity
Organization
Contact information
Practice address
720 MAIN AVE, ST MARIES, ID 83861-1849
(208) 245-2142
(208) 245-5650
Mailing address
PO BOX 384, ST MARIES, ID 83861-0384
(208) 245-2142
(208) 245-5650
Taxonomy
Speciality
Code
Description
License number
State
235500000X
Speech/Language/Hearing Specialist/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0028167
—
ID
Enumeration date
04/25/2007
Last updated
08/22/2020
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