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General NPI Number Information
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NPI Number | 1588206650
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Entity Type | Individual
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Provider Name | CLAIRE M'LYNN YOUNG LMT
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Gender | Female
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Dates
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Enumeration Date | 10/10/2019
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 309 E LOGAN ST
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City | CALDWELL
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State | ID
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Zip | 83605-4863
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Country | US
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Telephone | 208-455-0678
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Fax |
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Provider Business Mailing Address
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Address Line | 8431 W PEMBROOK DR
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City | BOISE
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State | ID
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Zip | 83704-4354
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | MAS-3060
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License Number State | ID
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