Individual
KATIE J DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
242 E 7TH N STE 4, REXBURG, ID 83440-3550
(208) 359-9683
Mailing address
649 N 2650 E, SAINT ANTHONY, ID 83445-5509
(208) 520-3204
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
COUL-9249
ID
101YS0200X
School Counselor
Primary
COUL-9249
ID
Other
Enumeration date
01/05/2023
Last updated
01/05/2023
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