Healthcare Provider Details

I. General information

NPI: 1629994579
Provider Name (Legal Business Name): ELLIE MCBRIDE PARAPROFESSIONAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 E CHUBBUCK RD
CHUBBUCK ID
83202-5055
US

IV. Provider business mailing address

265 E CHUBBUCK RD
CHUBBUCK ID
83202-5055
US

V. Phone/Fax

Practice location:
  • Phone: 208-237-1711
  • Fax: 208-237-9806
Mailing address:
  • Phone: 208-237-1711
  • Fax: 208-237-9806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: