Individual provider · Type 1 NPI

Logan Pluckebaum, IP

Developmental Therapist · Boise, ID

NPI number 1649158718 Active

Practice location

7557 W Ustick Rd
Boise, ID 83704-5810

Call (208) 890-4405 Map

Mailing address

443 E Hearthstone Dr
Boise, ID 83702-1727

Specialties and licenses

TaxonomyCodeLicense
Developmental Therapist Primary 222Q00000XNone listed

Developmental Therapist: A Developmental Therapist is a person qualified by completion of an approved program in Developmental Therapy and where applicable credentialed by the state and practicing within the scope of the credential, or credentialed by completion of education experiences as approved by the state and practicing within the scope of that credential or, where state credentialing does not exist, certified by the Board of the Deve…

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About NPI 1649158718

Logan Pluckebaum, IP's National Provider Identifier is 1649158718, issued on Aug 26, 2025. The primary taxonomy on file is Developmental Therapist (222Q00000X), and the practice location is in Boise, ID. The record was last updated on Aug 26, 2025.