NPI 1164563508
Idaho Dept of Health & Welfare Itp Region 6
Practice location
- Address
- 421 Memorial Dr, Pocatello, ID 83201-4008
- Phone
- (208) 234-7900
- Fax
- (208) 236-6328
Authorised official
- Name
- Mary J Jones
- Title
- Program Manager
- Phone
- (208) 334-5523
Registered specialties (2)
Early Intervention Provider Agency
Primary
Local Education Agency (LEA)
Registry record
- NPI
- 1164563508
- Entity type
- Organization
- NPI issued
- 9 Feb 2007
- Record last updated
- 5 Aug 2013
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.