Individual
MRS. MARDENE FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
10740 W FAIRVIEW AVE, SUITE 100, BOISE, ID 83713-7926
(208) 376-0191
(208) 658-6299
Mailing address
1837 E COUGAR CREEK DR, MERIDIAN, ID 83646-7343
(208) 887-6809
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-1071
ID
Other
Enumeration date
10/19/2006
Last updated
07/08/2007
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