Individual
MRS. AUTUMN L GUSDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BIS
Contact information
Practice address
210 E 14TH AVE, POST FALLS, ID 83854-7659
(208) 704-0717
Mailing address
210 E 14TH AVE, POST FALLS, ID 83854-7659
(208) 704-0717
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6071849
ID
106S00000X
Behavior Technician
—
—
Other
Enumeration date
09/13/2019
Last updated
12/19/2024
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