Individual
KRISTA PROFIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
609 E 5TH ST, SHOSHONE, ID 83352-5191
(971) 678-7865
Mailing address
609 E 5TH ST, SHOSHONE, ID 83352-5191
(971) 678-7865
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Enumeration date
01/06/2020
Last updated
01/06/2020
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