Healthcare Provider Details

I. General information

NPI: 1760680847
Provider Name (Legal Business Name): IDAHO SCHOOL FOR THE DEAF AND THE BLIND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 MAIN ST
GOODING ID
83330-1839
US

IV. Provider business mailing address

1450 MAIN ST
GOODING ID
83330-1839
US

V. Phone/Fax

Practice location:
  • Phone: 208-934-4457
  • Fax: 208-934-8352
Mailing address:
  • Phone: 208-934-4457
  • Fax: 208-934-8352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: GRETCHEN SPOONER
Title or Position: DIRECTOR OF CURRICULUM
Credential:
Phone: 208-934-4457