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Public Record Information
 
Name:  
Profession:  
Type:  
Number:  
Address Of Record:  
City/State/Zip:  
Country:  
Business Phone:  
Original Date of Issue:  
Registered/Licensed By:  
Status:  
Discipline Status:    
Expiration Date:  
 
Age Group:  
 
Activities:  
 
Status History
Date Action
3/8/2024 Renewed
3/8/2023 Renewed
6/14/2021 New License
Disciplinary Action Documents
 
None
 
 

NOTE: The information contained on this website is being made available as a public service by the Division of Occupational and Professional Licenses. The information on this site is made public pursuant to the Idaho Public Records Law. The data is derived directly from individual license applications entered into the database and is updated on a daily basis. Licensing credentials are primary-source verified and thus can be considered primary source license verification. None of the content contained on this website is intended to constitute legal or professional advice. Please note that some disciplinary actions against licensees may not appear immediately on the website. Appeals, effective dates of orders and other administrative processes may delay posting on the website. If additional certification  of this record is required, a written request must be submitted together with a $10.00 fee to the Division of Occupational and Professional Licenses, 11341 W. Chinden Blvd, Building #4, Boise, Idaho 83714.