Organization
INDEPENDENT GROWTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNDA BRENNEN (OWNER)
(208) 678-9165
Entity
Organization
Contact information
Practice address
2173 OVERLAND AVE, BOX 756, BURLEY, ID 83318-2927
(208) 678-9165
(208) 679-5985
Mailing address
PO BOX 756, BURLEY, ID 83318-0756
(208) 678-9165
(208) 679-5985
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0027664
—
ID
05
—
0027665
—
ID
Enumeration date
05/03/2007
Last updated
07/21/2022
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