Individual
AUDREY JEAN STALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2959 S MERIDIAN RD, MERIDIAN, ID 83642-7961
(208) 615-6389
Mailing address
412 N BROADMORE WAY APT 106, NAMPA, ID 83687-3271
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
25-494587
ID
Other
Enumeration date
01/16/2026
Last updated
01/16/2026
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