Individual
KELLY STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2705 E 17TH ST, AMMON, ID 83406-6669
(208) 346-7500
(208) 346-7501
Mailing address
2705 E 17TH ST, AMMON, ID 83406-6669
(208) 346-7500
(208) 346-7501
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-33495
ID
Other
Enumeration date
03/17/2014
Last updated
11/25/2025
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