Individual
MRS. DEBRA KELLERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
140 ALPINE LANE, HOPE, ID 83836-0175
(208) 264-5700
Mailing address
PO BOX 175, HOPE, ID 83836-0175
(208) 264-5700
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-24886
ID
Other
Enumeration date
03/04/2014
Last updated
03/04/2014
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