Individual
ELIZABETH RAE LAGAZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
150 SHOUP AVE, IDAHO FALLS, ID 83402-3657
(208) 528-4071
Mailing address
150 SHOUP AVE, IDAHO FALLS, ID 83402-3657
(208) 528-4071
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
10/31/2018
Last updated
10/31/2018
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