Provider Demographics
NPI:1235919994
Name:WARD, RICHARD ARNOLD
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ARNOLD
Last Name:WARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 N 4064 E
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5710
Mailing Address - Country:US
Mailing Address - Phone:208-390-9511
Mailing Address - Fax:
Practice Address - Street 1:272 N 4064 E
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5710
Practice Address - Country:US
Practice Address - Phone:208-221-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst