Individual
WADE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
310 N 2ND E, SUITE 128, REXBURG, ID 83440-1600
(208) 356-5675
(208) 356-5675
Mailing address
310 N 2ND E, SUITE 128, REXBURG, ID 83440-1600
(208) 356-5675
(208) 356-5675
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-27205
ID
Other
Enumeration date
06/27/2007
Last updated
07/08/2007
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