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General NPI Number Information
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NPI Number | 1376103713
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Entity Type | Organization
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Legal Business Name | IDAHO ANTI-TRAFFICKING COALITION
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 925 N MAIN ST
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City | MERIDIAN
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State | ID
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Zip | 83642-2301
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Country | US
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Telephone | 208-600-2184
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Fax |
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Provider Business Mailing Address
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Address Line | 868 E RIVERSIDE DR STE 170
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City | EAGLE
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State | ID
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Zip | 83616-6025
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Country | US
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Telephone | 208-630-6601
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Fax | 208-506-6851
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JENNIFER ZEILINSKI
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Credential |
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Telephone | 208-630-6601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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