Individual
LIESJE CHANTAL BOUWMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
89 N MAIN ST, DRIGGS, ID 83422-5141
(307) 734-6040
Mailing address
5375 N 3000 W, TETONIA, ID 83452-1201
(208) 527-6566
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
8921896
ID
Other
Enumeration date
01/14/2025
Last updated
01/14/2025
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