Healthcare Provider Details

I. General information

NPI: 1265363576
Provider Name (Legal Business Name): MINDEE ANDERSON AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 9TH ST STE 2B
RUPERT ID
83350-2207
US

IV. Provider business mailing address

1218 9TH ST STE 2B
RUPERT ID
83350-2207
US

V. Phone/Fax

Practice location:
  • Phone: 208-312-0957
  • Fax: 888-299-3160
Mailing address:
  • Phone: 208-312-0957
  • Fax: 888-299-3160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3381611
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: