Individual
JESSICA STODDARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD IN EDUCATION
Contact information
Practice address
908 S PENMARK AVE, KUNA, ID 83634-5394
(208) 602-0400
Mailing address
908 S PENMARK AVE, KUNA, ID 83634-5394
(208) 602-0400
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Enumeration date
04/22/2020
Last updated
04/22/2020
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