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General NPI Number Information
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NPI Number | 1164563508
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Entity Type | Organization
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Legal Business Name | IDAHO DEPT OF HEALTH & WELFARE ITP REGION 6
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/05/2013
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Provider Practice Location Address
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Address Line | 421 MEMORIAL DR
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City | POCATELLO
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State | ID
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Zip | 83201-4008
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Country | US
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Telephone | 208-234-7900
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Fax | 208-236-6328
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Provider Business Mailing Address
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Address Line | 421 MEMORIAL DR
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City | POCATELLO
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State | ID
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Zip | 83201-4008
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Country | US
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Telephone | 208-234-7900
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Fax | 208-236-6328
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MS. MARY J JONES
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Credential | B.U.S.
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Telephone | 208-334-5523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | ID
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