Individual
HAYDEN JONAH LESLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1087 EAST PARK BOULEVARD, BOISE, ID 83712
(208) 369-9168
Mailing address
1275 E TUTTLE ST, MERIDIAN, ID 83646-5932
(208) 912-3207
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/08/2023
Last updated
05/08/2023
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