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Individual
ERLAND DALE KIDDIE JR.
Active
Individual
ERLAND DALE KIDDIE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SOCIAL WORKER
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
122705-3502
UT
1041C0700X
Clinical Social Worker
Primary
404
MT
Other
Enumeration date
12/28/2007
Last updated
12/28/2007
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