Individual
MRS. BAILEY ANNE MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
732 HEIDI TER, KIMBERLY, ID 83341-5425
(209) 617-0033
Mailing address
732 HEIDI TER, KIMBERLY, ID 83341-5425
(209) 617-0033
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/17/2025
Last updated
01/17/2025
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