Individual
RAVEN KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
220 W GEORGIA AVE, NAMPA, ID 83686-2835
(208) 960-7474
Mailing address
4493 S MAVERICK WAY, BOISE, ID 83709-5428
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB1011374
CO
Other
Enumeration date
04/23/2024
Last updated
04/23/2024
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