Individual
MRS. DELIA MEDLIN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
422 17TH ST, LEWISTON, ID 83501-2526
(208) 743-4680
(208) 743-1756
Mailing address
PO BOX 2145, LEWISTON, ID 83501-1465
(208) 743-4680
(208) 743-1756
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY202098
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010140817
BLUESHIELD OF IDAHO
ID
01
—
N5640
BLUE CROSS OF IDAHO
ID
Enumeration date
08/29/2005
Last updated
07/08/2007
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