Individual
RYAN TEALL ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4745 N CASTLE HILLS AVE, BOISE, ID 83703-2765
(208) 626-4805
Mailing address
4909 N ELSINORE AVE APT K302, MERIDIAN, ID 83646-6970
(818) 940-8979
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/26/2022
Last updated
05/10/2025
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