Provider Information for 1013624485
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VAUGHN KNAPP LCSW
Sex: Male
NPI: 1013624485
Last Updated: 2022-11-03
Certification Date: 2022-11-03
Certification Date: 2022-11-03
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1013624485 | ||||||||
| Enumeration Date | 2022-11-03 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 818 W BRUMBACK ST BOISE, ID 83702-2824 United States Phone: 208-340-0665 | Fax: | ||||||||
| Primary Practice Address | 818 W BRUMBACK ST BOISE, ID 83702-2824 United States Phone: 208-340-0665 | Fax: | ||||||||
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