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Individual

WADE DARREN LEAVITT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LMSW

Contact information

Practice address
2275 W BROADWAY ST STE G, IDAHO FALLS, ID 83402-2902
(208) 861-2093
Mailing address
2275 W BROADWAY ST STE G, IDAHO FALLS, ID 83402-2902
(208) 861-2093

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-37989
ID

Other

Enumeration date
09/04/2018
Last updated
09/04/2018
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