Individual
KATIE CLEGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RTR
Contact information
Practice address
593 W 24TH ST, BURLEY, ID 83318-2803
(541) 690-4925
Mailing address
593 W 24TH ST, BURLEY, ID 83318-2803
(541) 690-4925
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
910569
OR
Other
Enumeration date
01/22/2020
Last updated
01/22/2020
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