Individual
AMBER MICKELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 E VENTURE WAY APT 5308, POCATELLO, ID 83201-1205
(208) 380-6968
Mailing address
1500 E VENTURE WAY APT 5308, POCATELLO, ID 83201-1205
(208) 380-6968
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-38418
ID
Other
Enumeration date
05/20/2025
Last updated
05/20/2025
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