Individual
LUIS ESTEBAN CHAVOLLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3700 W SELTICE WAY, COEUR D ALENE, ID 83814-8921
(208) 620-5250
Mailing address
PO BOX 1387, HAYDEN, ID 83835-1387
(208) 620-5250
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW-43041
ID
1041C0700X
Clinical Social Worker
Primary
8911211
ID
Other
Enumeration date
10/18/2018
Last updated
05/27/2025
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