Individual
BENJAMIN MARK SKAGGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
9196 W BARNES DR STE 45, BOISE, ID 83709-1552
(208) 433-0400
Mailing address
2409 N CHITWOOD WAY, BOISE, ID 83704-6009
(208) 989-5533
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LCSW-34723
ID
1041C0700X
Clinical Social Worker
LCSW-34723
ID
1041S0200X
School Social Worker
LCSW-34723
ID
Other
Enumeration date
06/08/2010
Last updated
04/12/2024
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