Individual
LOGAN BREONN ADAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3235 E OVERLAND RD, MERIDIAN, ID 83642-6711
(888) 392-8642
Mailing address
2791 S TEN MILE RD, MERIDIAN, ID 83642-6509
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-247596
FL
Other
Enumeration date
12/05/2022
Last updated
10/02/2024
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