Healthcare Provider Details

I. General information

NPI: 1083284483
Provider Name (Legal Business Name): EMILY CHRISTINE LASKOWSKI RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY SPELLMAN RDN

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E JEFFERSON ST
BOISE ID
83712-6231
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-7081
  • Fax: 208-381-6009
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-D-10215054
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD-1274
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: