Individual
DREW WILLIAM KISHPAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8020 W DORIAN ST, BOISE, ID 83709-2713
(208) 850-4811
Mailing address
8020 W DORIAN ST, BOISE, ID 83709-2713
(208) 850-4811
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/21/2021
Last updated
02/21/2021
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