Individual
LAURA DANIELLE HENRIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3022 S INDIANA AVE, CALDWELL, ID 83605-5929
(208) 600-3677
Mailing address
3022 S INDIANA AVE, CALDWELL, ID 83605-5929
(208) 600-3677
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
1
UT
Other
Enumeration date
10/17/2020
Last updated
10/17/2020
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