Individual
KELSEY LYNNE BLAZICEVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
923 GRANT ST, CALDWELL, ID 83605-4137
(208) 585-3375
(208) 585-6152
Mailing address
923 GRANT ST, CALDWELL, ID 83605-4137
(208) 585-3375
(208) 585-6152
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
06/24/2020
Last updated
06/24/2020
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