Individual
WILLOW R KENYON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
427 N 12TH ST, PLUMMER, ID 83851-0388
(208) 686-1931
(208) 686-0213
Mailing address
PO BOX 388, PLUMMER, ID 83851-0388
(208) 686-1931
(208) 686-0213
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-37482
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37482
LCSW
ID
Enumeration date
10/23/2015
Last updated
04/06/2022
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