Healthcare Provider Details

I. General information

NPI: 1285403659
Provider Name (Legal Business Name): KAMI DWELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 11TH AVE S STE 204
NAMPA ID
83651-5074
US

IV. Provider business mailing address

320 11TH AVE S STE 204
NAMPA ID
83651-5074
US

V. Phone/Fax

Practice location:
  • Phone: 208-541-2056
  • Fax:
Mailing address:
  • Phone: 208-541-2056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10085
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: