Jayson Egwuonwu
Individual provider Active NPI Behavior Technician · Boise, ID
NPI 1487288239 · NPPES record last updated Mar 1, 2020
Key facts
- NPI
- 1487288239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 12553 W Explorer Dr Ste 190
Boise, ID 83713-1612 - Phone
- (208) 972-5254
- NPI assigned
- Mar 1, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
12553 W Explorer Dr Ste 190
Boise, ID 83713-1612
Mailing address
12553 W Explorer Dr Ste 190
Boise, ID 83713-1612
Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2020. 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.