Individual
MR. STEPHEN RICHARD BUNNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
824 MCCORMICK RD, WEISER, ID 83672-5102
(208) 248-0477
Mailing address
824 MCCORMICK RD, WEISER, ID 83672-5102
(208) 248-0477
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-40292
ID
390200000X
Student in an Organized Health Care Education/Training Program
171560202
UT
Other
Enumeration date
12/04/2012
Last updated
08/28/2022
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