Individual
NICHOLE KOONCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
67 W GARFIELD AVE, GLENNS FERRY, ID 83623-5003
(208) 514-9037
Mailing address
PO BOX 565, GLENNS FERRY, ID 83623-0565
(208) 514-9037
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Enumeration date
11/04/2021
Last updated
11/04/2021
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