Individual
KIMBERLY M ROLLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2222 SCHILLER RD, EMMETT, ID 83617-9747
(360) 990-1483
Mailing address
2222 SCHILLER RD, EMMETT, ID 83617-9747
(360) 990-1483
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
AD003734N
ID
Other
Enumeration date
12/16/2019
Last updated
12/16/2019
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