Individual
CASSANDRA E RUSTVOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2500 W KOOTENAI ST, BOISE, ID 83705-2408
(208) 908-0500
Mailing address
2500 W KOOTENAI ST, BOISE, ID 83705-2408
(208) 908-0500
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
38617
ID
Other
Enumeration date
07/08/2019
Last updated
07/08/2019
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