Individual
CLAYDEN PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
540 3RD ST, IDAHO FALLS, ID 83401-3953
(208) 524-5607
Mailing address
1090 10TH ST, IDAHO FALLS, ID 83404-5063
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW 33236
ID
Other
Enumeration date
06/18/2014
Last updated
06/18/2014
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