Individual
BRIAN WIXOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
1720 N WESTGATE DR STE A-1, BOISE, ID 83704-7164
(208) 334-0734
(208) 334-0812
Mailing address
1720 N WESTGATE DR STE A-1, BOISE, ID 83704-7164
(208) 334-0734
(208) 334-0812
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW-2466
ID
Other
Enumeration date
04/06/2016
Last updated
12/02/2025
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