Individual
KAITLYN ELIZABETH GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
2420 E 25TH ST, IDAHO FALLS, ID 83404-7549
(208) 542-1026
Mailing address
2386 BROOKCLIFF DR, IDAHO FALLS, ID 83402-3836
(562) 883-3719
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
ID
Other
Enumeration date
09/18/2017
Last updated
09/18/2017
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