Individual
JONATHAN VINCENT NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
601 POLE LINE RD, TWIN FALLS, ID 83301-3035
(208) 814-7625
Mailing address
601 POLE LINE RD, TWIN FALLS, ID 83301-3035
(208) 814-7625
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-37479
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558606962
—
ID
Enumeration date
01/21/2014
Last updated
04/01/2025
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