Individual
BENJAMIN WALKER PENNOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1000
Mailing address
500 W FORT ST, BOISE, ID 83702-4501
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
3071063
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/17/2025
Last updated
05/15/2025
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