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General NPI Number Information
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NPI Number | 1497502496
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Entity Type | Individual
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Provider Name | SADIE BRIAR STULTZ
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Gender | Female
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Dates
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Enumeration Date | 05/06/2024
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 1087 E PARK BLVD SUITE 100
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City | BOISE
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State | ID
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Zip | 83712
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Country | US
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Telephone | 208-972-5254
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Fax |
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Provider Business Mailing Address
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Address Line | 886 WESTWOOD HEIGHTS RD
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City | SAGLE
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State | ID
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Zip | 83860-8744
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Country | US
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Telephone | 208-217-6062
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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