Individual
SIDRAH S KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
242 N 8TH ST STE 200, BOISE, ID 83702
(208) 447-9526
Mailing address
4714 N NYSTROM PL, BOISE, ID 83713-2522
(208) 447-9526
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
092550
NY
1041C0700X
Clinical Social Worker
Primary
72092550
NY
Other
Enumeration date
09/09/2014
Last updated
10/01/2018
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