Individual
ASHLEY METRONUS TRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
3330 E LOUISE DR STE 400, MERIDIAN, ID 83642-5123
(208) 513-3451
Mailing address
1920 S MANITOU AVE, BOISE, ID 83706-4148
(503) 280-1385
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-45032
ID
Other
Enumeration date
03/15/2018
Last updated
05/10/2024
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