Individual
PHOEBE TERRILL FILLMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4974 S BITTERCREEK AVE, MERIDIAN, ID 83642-7970
(208) 870-3379
Mailing address
3820 N TUPIZA AVE, MERIDIAN, ID 83646-4808
(626) 497-4119
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/20/2023
Last updated
02/20/2023
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