Individual
SHANNA CLAYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
150 S BROADWAY ST, BLACKFOOT, ID 83221-2711
(208) 785-1326
Mailing address
150 S BROADWAY ST, BLACKFOOT, ID 83221-2711
(208) 785-1326
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW-29104
ID
Other
Enumeration date
05/06/2014
Last updated
05/06/2014
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