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General NPI Number Information
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NPI Number | 1902098833
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Entity Type | Organization
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Legal Business Name | SCOTTISH RITE FOUNDATION OF IDAHO
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 564 SHOUP AVE W
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City | TWIN FALLS
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State | ID
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Zip | 83301-5029
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Country | US
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Telephone | 208-734-3914
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Fax | 208-734-3957
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Provider Business Mailing Address
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Address Line | 564 SHOUP AVE W
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City | TWIN FALLS
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State | ID
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Zip | 83301-5029
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Country | US
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Telephone | 208-734-3914
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Fax | 208-734-3957
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. MELODY ALLEN LENKNER
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Credential | M.A. CCC-SLP
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Telephone | 208-734-3914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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