Individual
LAURA WOLTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
353 E LANDER ST, POCATELLO, ID 83201-6314
(208) 261-2131
Mailing address
PO BOX 634, REXBURG, ID 83440-0634
(208) 261-2131
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC-7822
ID
101YM0800X
Mental Health Counselor
Primary
LPC-7822
ID
Other
Enumeration date
08/17/2020
Last updated
11/02/2022
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