Individual
FRED DAVID DODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2650 S EAGLE RD, MERIDIAN, ID 83642-6725
(986) 200-4290
Mailing address
2725 VIA VALDARNO, POCATELLO, ID 83201-5830
(512) 630-5140
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-40095
ID
Other
Enumeration date
05/04/2022
Last updated
05/04/2022
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