Individual
BRADY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1720 N WESTGATE DR, BOISE, ID 83704-7164
(208) 334-0800
Mailing address
1720 N WESTGATE DR, BOISE, ID 83704-7164
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
ID
Other
Enumeration date
02/01/2017
Last updated
02/01/2017
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