Individual
KASSIDI RENEE JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
2424 W BANK DR, BOISE, ID 83705-2565
(208) 342-3612
Mailing address
2424 W BANK DR, BOISE, ID 83705-2565
(208) 342-3612
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-39590
ID
Other
Enumeration date
03/02/2022
Last updated
03/02/2022
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