Individual
MR. JESSE RAY COBB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1210 NW 16TH ST, FRUITLAND, ID 83619-2202
(208) 452-8600
Mailing address
1210 NW 16TH ST, FRUITLAND, ID 83619-2202
(208) 452-8600
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-30921
ID
Other
Enumeration date
04/21/2015
Last updated
04/21/2015
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