MEDICARE: ANDREW LISH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst
2	103K00000X	Behavior Analyst
3	222Q00000X	Developmental Therapist	1-25-81998	ID

General Provider Information

NPI Number	:	1821759119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW LISH

Provider Business Mailing Address
First Line	:	705 E 2ND AVE # 104
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-7888
Country	:	US
Telephone Number	:	208-241-9715
Fax Number	:

Provider Business Practice Location Address
First Line	:	7905 N MEADOWLARK WAY STE D
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-5041
Country	:	US
Telephone Number	:	208-618-2593
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2022
Last Update Date	:	01/23/2026

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Directions to “ ANDREW LISH ” Practice Location

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