Individual
AMY HERZOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
175 BROME DR., #7, VICTOR, ID 83455
(406) 360-1631
Mailing address
175 BROME DR., 7, VICTOR, ID 83455
(406) 360-1631
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
WY
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
02/13/2007
Last updated
10/14/2009
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