Individual
NICOLE CORBRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
245 BANNOCK AVE, AMERICAN FALLS, ID 83211-1117
(208) 530-6317
Mailing address
245 BANNOCK AVE, AMERICAN FALLS, ID 83211-1117
(208) 530-6317
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Enumeration date
03/16/2022
Last updated
03/16/2022
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