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General NPI Number Information
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NPI Number | 1740386523
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Entity Type | Individual
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Provider Name | DAVID DEAN DELAWYER PHD
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 10/11/2019
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Provider Practice Location Address
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Address Line | 413 N ALLUMBAUGH ST STE 102
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City | BOISE
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State | ID
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Zip | 83704-9219
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Country | US
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Telephone | 208-389-2166
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Fax | 208-343-4458
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Provider Business Mailing Address
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Address Line | 413 N ALLUMBAUGH ST STE 102
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City | BOISE
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State | ID
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Zip | 83704-9219
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Country | US
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Telephone | 208-389-2166
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Fax | 208-343-4458
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY251
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License Number State | ID
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