Individual
CHRISTINA HOLLIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2705 E 17TH ST, AMMON, ID 83406-6601
(208) 346-7500
Mailing address
449 N 2500 E, SAINT ANTHONY, ID 83445-5740
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-40033
ID
106S00000X
Behavior Technician
—
—
Other
Enumeration date
06/22/2020
Last updated
07/27/2023
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