Individual
KENNETH E CHANDLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6138 W EMERALD ST STE B, BOISE, ID 83704-8857
(208) 367-3069
(208) 367-3002
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-3069
(208) 367-3002
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1280008
ID
Other
Enumeration date
06/18/2009
Last updated
06/18/2009
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