Provider Demographics
NPI:1346827144
Name:UHL, KEISHA M (RBT-21-160654)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:M
Last Name:UHL
Suffix:
Gender:F
Credentials:RBT-21-160654
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 E 17TH ST APT 42
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6476
Mailing Address - Country:US
Mailing Address - Phone:208-219-0889
Mailing Address - Fax:
Practice Address - Street 1:545 SHOUP AVE STE 22
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3575
Practice Address - Country:US
Practice Address - Phone:307-679-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRBT-21-160654106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician