Provider Demographics
NPI:1689268583
Name:DEWEES, KAMRYNN
Entity Type:Individual
Prefix:
First Name:KAMRYNN
Middle Name:
Last Name:DEWEES
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 1:2349 E OAKRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-6654
Mailing Address - Country:US
Mailing Address - Phone:775-686-4749
Mailing Address - Fax:
Practice Address - Street 1:3775 E APHRODITE CT
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-6997
Practice Address - Country:US
Practice Address - Phone:775-686-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician