Individual
SUSAN NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED
Contact information
Practice address
2604 16TH AVE, LEWISTON, ID 83501-3539
(208) 799-3460
Mailing address
2604 16TH AVE, LEWISTON, ID 83501-3539
(208) 799-3460
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
7019
ID
222Q00000X
Developmental Therapist
7029
ID
Other
Enumeration date
03/01/2016
Last updated
03/01/2016
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