Individual
CALEB IDLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
748 14TH AVE, LONGVIEW, WA 98632-2315
(360) 200-5419
(360) 200-6736
Mailing address
PO BOX 2394, LONGVIEW, WA 98632
(360) 200-5419
(360) 200-6736
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CG1106027
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2164312
—
WA
Enumeration date
09/14/2020
Last updated
10/29/2020
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