Healthcare Provider Details

I. General information

NPI: 1922674043
Provider Name (Legal Business Name): BRITTNEY D LYSKOSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2021
Last Update Date: 05/29/2021
Certification Date: 05/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 E 1ST ST
MIDDLETON ID
83644-5995
US

IV. Provider business mailing address

10753 EMPRESS ST
NAMPA ID
83687-9096
US

V. Phone/Fax

Practice location:
  • Phone: 208-473-0115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: