Individual
MARIE THERESA SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
600 N ROBBINS RD, BOISE, ID 83702-4565
(208) 385-3245
(208) 489-4053
Mailing address
600 N ROBBINS RD, ST LUKE'S REHAB HOSPITAL, BOISE, ID 83702
(208) 385-3245
(208) 489-4053
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW36042
ID
Other
Enumeration date
12/28/2016
Last updated
12/28/2016
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