Healthcare Provider Details

I. General information

NPI: 1548806201
Provider Name (Legal Business Name): CHARLENE RICARD BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHARLENE HOPKINS

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3323 4TH ST
LEWISTON ID
83501-4423
US

IV. Provider business mailing address

PO BOX 2169
LEWISTON ID
83501-1420
US

V. Phone/Fax

Practice location:
  • Phone: 208-553-0402
  • Fax:
Mailing address:
  • Phone: 208-553-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: