Individual
MR. JEFFERY PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1309 BENNETT AVE, BURLEY, ID 83318-2676
(208) 678-7796
Mailing address
2350 OAKLEY AVE, BURLEY, ID 83318-2924
(208) 831-6631
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-37640
ID
Other
Enumeration date
03/10/2016
Last updated
01/16/2025
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