Individual
ETHAN ISAAC KEIERLEBER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1087 E PARK BLVD, SUITE 100, BOISE, ID 83712
(208) 584-6130
Mailing address
8529 W FAIRVIEW AVE APT 303, BOISE, ID 83704-8589
(205) 718-4251
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Enumeration date
07/03/2025
Last updated
07/03/2025
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