Provider Demographics
NPI:1811193584
Name:HUMAN DYNAMICS AND DIAGNOSTICS PLLC
Entity Type:Organization
Organization Name:HUMAN DYNAMICS AND DIAGNOSTICS PLLC
Other - Org Name:HUMAN DYNAMICS AND DIAGNOSTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:AGENCY OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FREEMAN
Authorized Official - Last Name:SPIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-522-0140
Mailing Address - Street 1:404 W CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:KELLOGG
Mailing Address - State:ID
Mailing Address - Zip Code:83837-2111
Mailing Address - Country:US
Mailing Address - Phone:208-783-2804
Mailing Address - Fax:208-783-2805
Practice Address - Street 1:404 W CAMERON AVE
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837-2111
Practice Address - Country:US
Practice Address - Phone:208-783-2804
Practice Address - Fax:208-783-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health