| Periwinkle Children's Therapy | |
|
917 W Canfield Ave Coeur D Alene ID 83815-9764 | |
| (208) 762-3502 | |
| Not Available |
| Full Name | Periwinkle Children's Therapy |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 917 W Canfield Ave, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Michelle Coppess (OWNER) |
| Authorized Official Contact | 2088184573 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Periwinkle Children's Therapy 917 W. Canfield Ave Coeur D Alene ID 83815-9764 Ph: () - | Periwinkle Children's Therapy 917 W Canfield Ave Coeur D Alene ID 83815-9764 Ph: (208) 762-3502 |
| NPI Number | 1598211856 |
|---|---|
| Provider Enumeration Date | 08/28/2016 |
| Last Update Date | 08/28/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598211856 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | TSLP-3021 (Idaho) | Primary |
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