Individual
KRISTEN RAY BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
109 E BANNOCK ST, BOISE, ID 83712
(208) 381-2222
Mailing address
13698 W ROCHESTER ST, BOISE, ID 83713-1924
(208) 602-9305
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-41872
ID
Other
Enumeration date
06/04/2018
Last updated
03/30/2023
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