Individual
MIRIAM PATRICIA SOUTHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1720 N WESTGATE DR STE A-1, BOISE, ID 83704-7164
(208) 334-0800
Mailing address
1720 N WESTGATE DR STE A-1, BOISE, ID 83704-7164
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
04/24/2019
Last updated
04/24/2019
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