Provider Demographics
NPI:1346876539
Name:SHALZ, APRIL LOUISE
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:LOUISE
Last Name:SHALZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E HERITAGE PARK ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6293
Mailing Address - Country:US
Mailing Address - Phone:208-484-5327
Mailing Address - Fax:
Practice Address - Street 1:515 E HERITAGE PARK ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6293
Practice Address - Country:US
Practice Address - Phone:208-484-5327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician