Individual
RONALD WILSON ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
1740 E 17TH ST, IDAHO FALLS, ID 83404-6375
(208) 346-8866
Mailing address
1740 E 17TH ST, IDAHO FALLS, ID 83404-6375
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
05/25/2012
Last updated
05/25/2012
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