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General NPI Number Information
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NPI Number | 1760845770
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Entity Type | Individual
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Provider Name | JAMIE ACHENBACH
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Gender | Female
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 08/07/2019
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Provider Practice Location Address
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Address Line | 372 S EAGLE RD # 320
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City | EAGLE
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State | ID
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Zip | 83616-5908
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Country | US
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Telephone | 260-409-5724
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Fax |
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Provider Business Mailing Address
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Address Line | 4810 N GLENBROOK DR
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City | BOISE
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State | ID
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Zip | 83704-2161
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Country | US
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Telephone | 260-409-5724
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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