Individual
CHARLENE RICARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BI
Contact information
Practice address
1215 BRYDEN AVE, LEWISTON, ID 83501-5348
(208) 553-8650
Mailing address
1215 BRYDEN AVE, LEWISTON, ID 83501-5348
(208) 553-8650
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A0004105
—
ID
Enumeration date
11/18/2019
Last updated
01/12/2020
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