Individual
MR. BLAINE E MCINELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.ED.
Contact information
Practice address
1740 E 17TH ST, IDAHO FALLS, ID 83404-6375
(208) 520-3304
Mailing address
1740 E 17TH ST, IDAHO FALLS, ID 83404-6375
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
08/24/2011
Last updated
08/24/2011
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