Individual
MISS MEGAN MICHELLE MACNEIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
938 POULSON ST, IDAHO FALLS, ID 83401-2142
(501) 513-7638
Mailing address
3653 HIDDEN HAVEN ST, AMMON, ID 83406-7509
(501) 513-7638
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106S00000X
—
ID
Enumeration date
06/14/2021
Last updated
06/14/2021
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