NPI 1407572118

Spencer Wendell Olson

Practitioner Child Intellectual and/or Developmental Disabilities Respite Care Shelley, ID

Practice location

Address: 205 Spruce St, Shelley, ID 83274-1441
Phone: (208) 360-4294

Registered specialties

Child Intellectual and/or Developmental Disabilities Respite Care Primary

Respite Care Facility Taxonomy 385HR2060X

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Registry record

NPI: 1407572118
Entity type: Individual
Sex (as registered): Male
NPI issued: 13 Oct 2022
Record last updated: 13 Oct 2022

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.