Individual
JONATHAN MARCEL MOSES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
295 N 3855 E, RIGBY, ID 83442-5124
(208) 745-5205
Mailing address
2275 W BROADWAY ST, IDAHO FALLS, ID 83402-2902
(208) 524-7400
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-42172
ID
Other
Enumeration date
05/31/2019
Last updated
05/10/2022
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