Individual
MR. BRENT STANLEY PACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS
Contact information
Practice address
1190 YORK DR, BLACKFOOT, ID 83221-3621
(208) 201-0144
Mailing address
1190 YORK DR, BLACKFOOT, ID 83221-3621
(208) 201-0144
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
12/26/2012
Last updated
12/26/2012
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