Individual
MS. SHELLY RAE HUMPHREYS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
331 S MAIN ST, SODA SPRINGS, ID 83276-1629
(208) 530-0326
Mailing address
331 S MAIN ST, SODA SPRINGS, ID 83276-1629
(208) 530-0326
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Enumeration date
01/03/2022
Last updated
01/03/2022
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