Individual
AVERY BOLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
417 S 6TH ST, BOISE, ID 83702-7632
(208) 577-4460
Mailing address
2630 S GATEWOOD LN, BOISE, ID 83709-8576
(208) 941-1966
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-41698
ID
Other
Enumeration date
02/14/2022
Last updated
02/14/2022
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