Individual
MALLORY MARIE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2616
(208) 381-3042
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2616
(208) 381-3042
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-37154
ID
Other
Enumeration date
02/14/2018
Last updated
02/14/2018
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