Individual
DIANA UPPENDAHL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
531 BRYDEN AVE, LEWISTON, ID 83501-4438
(208) 798-1646
Mailing address
531 BRYDEN AVE, LEWISTON, ID 83501-4438
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
—
—
Other
Enumeration date
12/12/2025
Last updated
12/12/2025
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