Individual
J REED STODDARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
200 SHC, REXBURG, ID 83460-2020
(208) 496-1100
Mailing address
249 S MILLHOLLOW RD, REXBURG, ID 83440-2221
(208) 496-1100
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-945
ID
Other
Enumeration date
11/29/2006
Last updated
07/08/2007
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