Individual
UNCIL GRACE JO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2922 CLEVELAND BLVD STE 500, CALDWELL, ID 83605-6962
(208) 453-1439
Mailing address
11491 W WAGON PASS CT, BOISE, ID 83709-8565
(208) 345-6202
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-30053
ID
Other
Enumeration date
01/06/2010
Last updated
04/01/2010
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