Individual
KERIN ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
717 N 11TH ST, BOISE, ID 83702-5365
(208) 319-1002
Mailing address
PO BOX 801, BOISE, ID 83701-0801
(208) 342-0272
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-4248
ID
Other
Enumeration date
07/28/2009
Last updated
07/28/2009
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