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AMY E. LATTA, PH.D., P.A.

Clinical Neuropsychologist

Boise, Idaho

Provider NPI: 1265677298

Organization Information:
Organization Name:  AMY E. LATTA, PH.D., P.A.
Organization is not Subpart
Authorized Official:  AMY E LATTA  PRESIDENT  208-2508939

Practice Location:
1020 W MAIN ST SUITE 100B BOISE, ID 83702 US
Tel: 208-250-8939  Fax: 208-229-4099

Business Mailing Address:
7154 W STATE ST #106 BOISE, ID 83714 US
Tel: 208-250-8939  Fax: 208-229-4099

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
IDPSY202458

Other Provider Identifiers:

IssuerNumberStateType
INDIVIDUAL NPI1750536264ID01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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