NPI age
9 years
Enumerated 2016-09-01
Across 2000 active social worker providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (UT) | 8139486-3501 | UTAH LICENSE |
| 01 (ID) | LCSW-36039 | PROFESSIONAL STATE LICENSE |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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