Individual
MS. DORTHY C CLAYTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW LCSW
Contact information
Practice address
300 W ANDERSON ST, IDAHO FALLS, ID 83402-2141
(208) 523-8721
(208) 523-8721
Mailing address
300 W ANDERSON ST, IDAHO FALLS, ID 83402-2141
(208) 523-8721
(208) 523-8721
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LCSW545
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015878
REGENCE BLUE SHIELD
ID
01
—
L5451
BLUE CROSS
ID
Enumeration date
09/23/2005
Last updated
07/08/2007
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