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Individual

RUSSELL LYNN VOLLMER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
215 E 50 S STE 5, MALAD CITY, ID 83252-2300
(208) 766-2365
(208) 766-2364
Mailing address
2672 N 3100 W, MALAD CITY, ID 83252-6519
(208) 637-9813

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
286822-3501
UT
1041C0700X
Clinical Social Worker
286822-3501
UT
1041C0700X
Clinical Social Worker
LCSW-36911
ID
1041C0700X
Clinical Social Worker
LSW-28623
ID

Other

Enumeration date
05/08/2014
Last updated
03/06/2023
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