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1336697366
SHANE WEIDEMAN
EMMETT, ID
NPI
1336697366
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: ID LPC-6270)
Enumeration Date
2016-09-19
Last Update Date
2016-09-19
Business Address
-- SHANE WEIDEMAN
2007 E QUAIL RUN RD
EMMETT, ID 83617-5059
Phone number: 208-365-5445
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Mailing Address
-- SHANE WEIDEMAN
2305 VALLEY VIEW DR
WEISER, ID 83672-1245
Phone number: 208-540-0226
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