Individual
LACEY JANE WUTHRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1777 E CLARK ST STE 330, POCATELLO, ID 83201-3357
(208) 233-5433
(877) 284-2783
Mailing address
1777 E CLARK ST STE 330, POCATELLO, ID 83201-3357
(208) 233-5433
(877) 284-2783
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
10/20/2017
Last updated
10/20/2017
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