Individual
MAKENNA DUSTY RUDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
33 E IDAHO AVE UNIT 308B, MERIDIAN, ID 83642-1144
(208) 412-7903
Mailing address
33 E IDAHO AVE UNIT 308B, MERIDIAN, ID 83642-1144
(208) 412-7903
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Enumeration date
05/28/2025
Last updated
05/28/2025
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