Healthcare Provider Details

I. General information

NPI: 1124240452
Provider Name (Legal Business Name): COUNTY OF LATAH JOINT SCHOOL DISTRICT 283
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 HIGHWAY 3
KENDRICK ID
83537-9739
US

IV. Provider business mailing address

2001 HIGHWAY 3 P.O. BOX 283
KENDRICK ID
83537-9739
US

V. Phone/Fax

Practice location:
  • Phone: 208-289-4211
  • Fax:
Mailing address:
  • Phone: 208-289-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number8065625
License Number StateID

VIII. Authorized Official

Name: MELISSA EICHNER
Title or Position: DISTRICT SECRETARY
Credential:
Phone: 208-289-4211