Individual
MARY MARDELL SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
540 3RD ST, IDAHO FALLS, ID 83401-3953
(208) 524-5607
Mailing address
306 E 24TH ST, IDAHO FALLS, ID 83404-6947
(208) 528-6364
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-1005
ID
Other
Enumeration date
10/16/2008
Last updated
10/16/2008
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