Individual
TIFFANY BAILLY-RENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1200 W IRONWOOD DR, COEUR D ALENE, ID 83814-2660
(208) 664-9729
(208) 263-7515
Mailing address
4736 E DEER RD, HARRISON, ID 83833-7894
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
30167
ID
Other
Enumeration date
05/24/2010
Last updated
05/24/2010
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