Individual
CORRY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
85 S MIDDLETON RD, NAMPA, ID 83651-1526
(208) 505-2800
(208) 505-2801
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-45159
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1041C0700X
—
UT
Enumeration date
01/02/2018
Last updated
08/05/2024
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