Individual
MS. KATHY MATLOCK TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5999 W STATE ST STE B, BOISE, ID 83703-3039
(208) 853-5095
(208) 853-5125
Mailing address
7285 W FRANKLIN RD, BOISE, ID 83709-0926
(208) 853-5095
(208) 853-5125
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW 858
ID
Other
Enumeration date
01/20/2007
Last updated
09/16/2019
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