Individual
BRAD JOSEPH NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LMSW
Contact information
Practice address
455 WASHIGTON ST, STE 2, MONTPELIER, ID 83254-1600
(208) 847-4464
(208) 847-3093
Mailing address
455 WASHINGTON ST STE 2, MONTPELIER, ID 83254-1600
(208) 847-4464
(208) 847-3093
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-38058
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805405600
—
ID
Enumeration date
09/20/2018
Last updated
04/05/2021
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