Individual
MR. GLENN ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW1887
Contact information
Practice address
1740 E 17TH ST STE B, IDAHO FALLS, ID 83404-6375
(208) 529-8832
(208) 522-8725
Mailing address
1740 E 17TH ST STE B, IDAHO FALLS, ID 83404-6375
(208) 529-8832
(208) 522-8725
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW1887
ID
Other
Enumeration date
01/14/2008
Last updated
01/14/2008
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