Individual
MR. KIRK LYNN MACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
218 DIVIDEND DR STE 3, REXBURG, ID 83440-3510
(208) 359-9683
(208) 359-9683
Mailing address
679 W STONEBRIDGE, REXBURG, ID 83440-5193
(208) 656-0409
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW-2660
ID
Other
Enumeration date
04/09/2007
Last updated
07/08/2007
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