Individual
CHANDLER JAMES THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7905 N MEADOWLARK WAY STE D, COEUR D ALENE, ID 83815-5041
(208) 417-7509
Mailing address
1617 E LADY BUG LN, HAYDEN, ID 83835-8338
(208) 518-7434
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NIS971500383
BLUE CROSS OF IDAHO
ID
Enumeration date
03/18/2022
Last updated
03/18/2022
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