Laken Craig Alles, RBT
Individual provider Active NPI Behavior Technician · Driggs, ID
NPI 1306403233 · NPPES record last updated May 27, 2019
Key facts
- NPI
- 1306403233
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- License
- RBT-19-87844 (ID)
- Practice address
- 30 E Little Ave
Driggs, ID 83422-5138 - Phone
- (307) 257-5487
- NPI assigned
- May 27, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-19-87844 | ID | MD | Behavior Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-19-87844 | ID | Yes |
Addresses
Primary practice location
30 E Little Ave
Driggs, ID 83422-5138
Mailing address
PO Box 11231
Jackson, WY 83002-1231
Phone (804) 614-5853
Other providers in Driggs, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 27, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.