Healthcare Provider Details

I. General information

NPI: 1518634435
Provider Name (Legal Business Name): ELIZABETH G DANIELS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 CENTER AVE
PAYETTE ID
83661-2535
US

IV. Provider business mailing address

418 1/2 S 11TH ST
PAYETTE ID
83661-3329
US

V. Phone/Fax

Practice location:
  • Phone: 208-907-2650
  • Fax:
Mailing address:
  • Phone: 208-907-2650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: