Individual
MICHAEL E WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2805 BLAINE ST, STE 120, CALDWELL, ID 83605-4599
(208) 459-4412
(208) 454-7296
Mailing address
5563 W LUCKY DR, BOISE, ID 83703-3188
(208) 724-9276
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-804
ID
Other
Enumeration date
04/24/2007
Last updated
03/08/2011
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