Individual
ANGIE JO RADFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1675 CURLEW DRIVE, AMMON, ID 83406
(208) 529-4300
Mailing address
3061 N MIDNIGHT BLUE DRIVE, IDAHO FALLS, ID 83401
(208) 529-4300
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LMSW - 27203
ID
Other
Enumeration date
09/06/2006
Last updated
07/08/2007
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