Provider Demographics
NPI:1821049784
Name:KIDD, YANCIE JOHN (AUD)
Entity Type:Individual
Prefix:DR
First Name:YANCIE
Middle Name:JOHN
Last Name:KIDD
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 E 2ND N
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:ID
Mailing Address - Zip Code:83445-1612
Mailing Address - Country:US
Mailing Address - Phone:208-403-5450
Mailing Address - Fax:
Practice Address - Street 1:218 DIVIDEND DR
Practice Address - Street 2:SUITE 2
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-3556
Practice Address - Country:US
Practice Address - Phone:208-359-2727
Practice Address - Fax:208-359-5468
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD-1081231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist