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Individual

RICHARD BLOXHAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LSW

Contact information

Practice address
421 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 234-7900
Mailing address
421 MEMORIAL DR, POCATELLO, ID 83201-4008

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW-2395
ID

Other

Enumeration date
03/28/2016
Last updated
03/28/2016
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