Individual
MARY KAY GORDON-BRUNNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
314 BADIOLA ST, CALDWELL, ID 83605-4389
(702) 589-4871
Mailing address
PO BOX 264, MIDDLETON, ID 83644-0264
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-33403
ID
Other
Enumeration date
07/03/2023
Last updated
08/10/2023
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