SHANE WEIDEMAN

EMMETT, ID
NPI1336697366
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YM0800X Counselor, Mental Health
(Licence: ID  LPC-6270)
Enumeration Date2016-09-19
Last Update Date2016-09-19
Business Address
-- SHANE WEIDEMAN
2007 E QUAIL RUN RD
EMMETT, ID 83617-5059
Phone number: 208-365-5445
Mailing Address
-- SHANE WEIDEMAN
2305 VALLEY VIEW DR
WEISER, ID 83672-1245
Phone number: 208-540-0226
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