Individual
MS. TERESA I SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
7275 W POTOMAC DR, STE. A, BOISE, ID 83704-9150
(208) 284-0377
Mailing address
6263 W COHIBA LN, BOISE, ID 83703-2848
(208) 284-0377
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-31375
ID
Other
Enumeration date
09/30/2012
Last updated
09/30/2012
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