Idaho Dept of Health & Welfare Itp Region 4

NPI #1568502409 in Boise, Idaho

Provider Information

NPI Number: 1568502409
Entity Type: Organization
Organization Name: Idaho Dept of Health & Welfare Itp Region 4
Primary Specialty: Early Intervention Provider Agency
Enumeration Date: Feb 8, 2007
Last Updated: Aug 5, 2013

Practice Location

Address: 1720 WESTGATE DR
Address 2: SUITE B-2
City: Boise
State: Idaho
ZIP Code: 83704-7164
Phone: (208) 334-0900

Authorized Official

Name: MARY J JONES, B.U.S.
Title: PROGRAM MANAGER
Phone: (208) 334-5523

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Local Education Agency (LEA)	251300000X
Early Intervention Provider Agency	252Y00000X	Primary

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