Individual
DIANNE NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
2265 W BROADWAY ST, IDAHO FALLS, ID 83402-2996
(208) 524-7400
Mailing address
2265 W BROADWAY ST, IDAHO FALLS, ID 83402-2996
(208) 524-7400
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
45194
ID
Other
Enumeration date
05/21/2024
Last updated
05/21/2024
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