Individual
MRS. DARA J. EZZELL-PEBWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
28371 EL PASO RD BLDG A, CALDWELL, ID 83607-7521
(208) 972-5514
Mailing address
1871 SPANISH FORK WAY APT N204, MERIDIAN, ID 83642-5650
(208) 389-8338
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
42343
ID
Other
Enumeration date
06/10/2022
Last updated
05/14/2024
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