Individual
MANDY FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1777 E CLARK ST STE 330, POCATELLO, ID 83201-3357
(208) 478-9081
Mailing address
195 CHARLES PL, POCATELLO, ID 83201-3248
(208) 252-1764
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW-39280
ID
1041C0700X
Clinical Social Worker
Primary
8861300
ID
Other
Enumeration date
11/16/2020
Last updated
11/12/2024
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