Individual
LUCAS SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
861 LAKESIDE DR, BLACKFOOT, ID 83221-1674
(208) 360-7355
Mailing address
861 LAKESIDE DR, BLACKFOOT, ID 83221-1674
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
—
Other
Enumeration date
11/27/2023
Last updated
11/27/2023
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