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Individual

ETHAN SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LMSW

Contact information

Practice address
540 3RD ST, IDAHO FALLS, ID 83401-3953
(208) 524-5607
Mailing address
540 3RD ST, IDAHO FALLS, ID 83401-3953

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary

Other

Enumeration date
10/11/2013
Last updated
10/11/2013
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