Individual
MS. DESIREE ANN SELF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
244 S SILVERWOOD WAY, EAGLE, ID 83616-6165
(440) 228-7161
Mailing address
244 S SILVERWOOD WAY, EAGLE, ID 83616-6165
(440) 228-7161
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Enumeration date
07/12/2021
Last updated
07/12/2021
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