Organization
PERIWINKLE CHILDREN'S THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE COPPESS M.S. (OWNER)
(208) 818-4573
Entity
Organization
Contact information
Practice address
917 W CANFIELD AVE, COEUR D ALENE, ID 83815-9764
(208) 762-3502
Mailing address
917 W. CANFIELD AVE, COEUR D ALENE, ID 83815-9764
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
TSLP-3021
ID
Other
Enumeration date
08/28/2016
Last updated
08/28/2016
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