Individual
ELIZABETH MARY WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1087 E PARK BLVD, BOISE, ID 83712
(208) 369-9168
Mailing address
2628 S SIMSBURY PL, BOISE, ID 83709-8535
(208) 995-2839
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/31/2022
Last updated
05/31/2022
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