Individual
CHARLES GREGORY WHIPPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
6633 W WRIGHT ST, BOISE, ID 83709-4354
(208) 375-7777
(208) 375-7598
Mailing address
6633 W WRIGHT ST, BOISE, ID 83709-4354
(208) 375-7777
(208) 375-7598
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW773
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCSW773
IDAHO LICENSE
ID
Enumeration date
12/07/2010
Last updated
12/07/2010
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