Individual
KAYLA PEDIGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1309 CAMAS ST, BLACKFOOT, ID 83221-3060
(208) 782-0675
Mailing address
1309 CAMAS ST, BLACKFOOT, ID 83221-3060
(208) 782-0675
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC 5608
ID
Other
Enumeration date
08/16/2016
Last updated
08/16/2016
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