Provider Demographics
NPI:1396030896
Name:SWETLAND, KYLEE
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:SWETLAND
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 1:7447 W EMERALD ST
Mailing Address - Street 2:STE 150
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5003
Mailing Address - Country:US
Mailing Address - Phone:208-344-3744
Mailing Address - Fax:
Practice Address - Street 1:7447 W EMERALD ST
Practice Address - Street 2:STE 150
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5003
Practice Address - Country:US
Practice Address - Phone:208-344-3744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMX110009225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist