Individual
CARISSA LEANN SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 E HALLIDAY ST, POCATELLO, ID 83201-4824
(208) 860-8987
Mailing address
1110 E HALLIDAY ST, POCATELLO, ID 83201-4824
(208) 860-8987
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/24/2023
Last updated
10/24/2023
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