Individual
MR. RUSSELL ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
150 SHOUP AVE, IDAHO FALLS, ID 83402-3657
(208) 522-5700
Mailing address
150 SHOUP AVE, IDAHO FALLS, ID 83402-3657
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW-30045
ID
Other
Enumeration date
03/28/2016
Last updated
03/28/2016
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