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Individual

JOSHUA RANDALL GRADE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
1322 W VERBENA DR, MERIDIAN, ID 83642-1238
(208) 559-6197
Mailing address
1322 W VERBENA DR, MERIDIAN, ID 83642-1238
(208) 559-6197

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-40892
ID

Other

Enumeration date
05/11/2017
Last updated
07/29/2024
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