Individual
RANDY RODRIQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
150 SHOUP AVE STE 17, IDAHO FALLS, ID 83402-3653
(208) 528-5700
(208) 528-4747
Mailing address
150 SHOUP AVE STE 17, IDAHO FALLS, ID 83402-3653
(208) 528-5700
(208) 528-4747
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1083
ID
Other
Enumeration date
03/28/2019
Last updated
03/28/2019
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