Individual
KELLY E WEDEVEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
131 N ALLUMBAUGH ST, BOISE, ID 83704-9204
(208) 367-2175
(208) 376-0285
Mailing address
131 N ALLUMBAUGH ST, BOISE, ID 83704-9204
(208) 367-2175
(208) 376-0285
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW24754
ID
Other
Enumeration date
07/14/2006
Last updated
06/15/2023
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