Individual
KACEY SARESA MCDONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
400 N BENJAMIN LN, BOISE, ID 83704-5094
(208) 287-7660
Mailing address
400 N BENJAMIN LN, BOISE, ID 83704-5094
(208) 287-7660
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
41551
ID
Other
Enumeration date
02/08/2022
Last updated
02/08/2022
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