Individual
NATHAN DAVID MATTESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1087 E PARK BLVD, SUITE 100, BOISE, ID 83712
(208) 369-9168
Mailing address
10211 CHERRY LN, APT #302, NAMPA, ID 83687
(605) 520-9596
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Enumeration date
02/28/2025
Last updated
02/28/2025
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