Healthcare Provider Details

I. General information

NPI: 1255156170
Provider Name (Legal Business Name): CORIE CHRISTINE POUNDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W GEORGIA AVE
NAMPA ID
83686-2835
US

IV. Provider business mailing address

1717 W PLUM CT
NAMPA ID
83651-8352
US

V. Phone/Fax

Practice location:
  • Phone: 425-368-3262
  • Fax:
Mailing address:
  • Phone: 208-957-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: