Healthcare Provider Details

I. General information

NPI: 1639051980
Provider Name (Legal Business Name): KAYLA DAWNE SALISBURY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 291
WHITE BIRD ID
83554-0271
US

IV. Provider business mailing address

PO BOX 291
WHITE BIRD ID
83554-0271
US

V. Phone/Fax

Practice location:
  • Phone: 208-553-5344
  • Fax:
Mailing address:
  • Phone: 208-553-5344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1671170
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: