Individual
DALLAS R SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
44 N MAIN ST, MALAD CITY, ID 83252-1200
(208) 766-2389
Mailing address
44 N MAIN ST, MALAD CITY, ID 83252-1200
(208) 766-2389
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW - 31018
ID
Other
Enumeration date
03/15/2011
Last updated
03/15/2011
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