Individual
KENDALL LOGAN NEBEKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4943 N 29TH E # B, IDAHO FALLS, ID 83401-1314
(307) 257-5487
Mailing address
PO BOX 20310, PMB 55984, CHEYENNE, WY 82003-1970
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396085718
—
UT
Enumeration date
04/26/2022
Last updated
01/04/2024
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