Individual
KAM NELSON-KNISLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
3288 E PINE AVE, MERIDIAN, ID 83642-5922
(208) 888-8887
Mailing address
10749 W REUTZEL DR, BOISE, ID 83709-5029
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
36232
ID
Other
Enumeration date
02/13/2018
Last updated
02/13/2018
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