Individual
TRACI L BIRDSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
312 MILLER ST, LEWISTON, ID 83501-1944
(208) 750-1802
Mailing address
3415 7TH ST, LEWISTON, ID 83501-4903
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-45152
ID
Other
Enumeration date
05/18/2024
Last updated
05/18/2024
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