Peregrine Corp, Pc | |
37 Highway 57 Priest River ID 83856-6559 | |
(208) 448-4855 | |
(208) 448-2467 |
Full Name | Peregrine Corp, Pc |
---|---|
Speciality | Counselor - Mental Health |
Location | 37 Highway 57, Priest River, Idaho |
Authorized Official Name and Position | Dorlea Ann Knizley (BOARD PRESIDENT) |
Authorized Official Contact | 2084484855 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Peregrine Corp, Pc Po Box 205 Priest River ID 83856-0205 Ph: (208) 448-4855 | Peregrine Corp, Pc 37 Highway 57 Priest River ID 83856-6559 Ph: (208) 448-4855 |
NPI Number | 1093040917 |
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Provider Enumeration Date | 10/09/2009 |
Last Update Date | 09/25/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093040917 | NPI | - | NPPES |
807375500 | Medicaid | ID | |
Q2776 | Other | BLUE CROSS OF IDAHO | |
000010016976 | Other | REGENCE BLUESHIELD | |
807348800 | Medicaid | ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | LCPC - 139 (Idaho) | Primary |
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