NPI age
18 years
Enumerated 2007-08-30
Across 235 active psychologist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 805455300 | |
| 01 (ID) | 000010017563 | BLUE SHIELD |
| 01 (ID) | N5228 | BLUE CROSS |
| 01 | 1194837351 | GROUP NPI |
Part of a multi-provider practice. 5 other active providers share this practice address in NPPES.
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