Duclos, Kody Michael

Duclos, Kody Michael is an individual health care provider with primary practice located at 305 E Jefferson St , Boise ID 83712-6231. He recently has only one registered license in Dietary & Nutritional Service Providers / Nutrition, Pediatric, which is considered as his primary health care specialty. Duclos, Kody Michael can be contacted via phone (208) 381-7081.

Contact Information

Primary practice address
305 E Jefferson St Boise ID 83712-6231
Phone: (208) 381-7081
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Nutrition, Pediatric 133VN1004X 86117056 Idaho

Profile Details

NPI number 1033748124
LBN Legal business name Duclos, Kody Michael
Credentials RD, LD
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 2nd, 2020
Last updated Apr 2nd, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033748124 NPPES
Idaho Other 86117056 COMMISSION ON DIETETIC REGISTRATION

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