Individual
KAYLEE MARIE ETHRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
101 S MAIN ST, POCATELLO, ID 83204-3210
(208) 232-8840
Mailing address
4317 OPAL AVE TRLR 36, POCATELLO, ID 83204-2145
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
5271240
ID
Other
Enumeration date
01/16/2025
Last updated
07/18/2025
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