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Individual

KENDAL MICHELLE TUCKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
2501 S GATEWOOD LN, BOISE, ID 83709-8575
(208) 841-0957
Mailing address
PO BOX 190986, BOISE, ID 83719-0986
(208) 841-0952

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-4233
ID

Other

Enumeration date
09/29/2009
Last updated
09/29/2009
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