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Individual

DAN TADLOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
6426 KOOTENAI STREET, SUITE 103, BONNERS FERRY, ID 83805-5005
(208) 291-1516
Mailing address
PO BOX 1014, BONNERS FERRY, ID 83805-1014
(208) 255-9460

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-29379
ID

Other

Enumeration date
12/15/2011
Last updated
03/27/2026
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