Individual
DYLAN MARSHALL LANDEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1810 W BROADWAY ST, IDAHO FALLS, ID 83402-5072
(208) 206-7613
Mailing address
2300 S CHARLOTTE DR, IDAHO FALLS, ID 83402-5675
(208) 206-7613
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-42552
ID
Other
Enumeration date
09/09/2022
Last updated
09/09/2022
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