Wade Gordon, LCSW Valid NPI
Individual provider · Clinical Social Worker · Rexburg, ID
- NPI
- 1376740134
- Type
- Individual (Type 1)
- Primary specialty
- Clinical Social Worker (Social Worker)
- Specialty group
- Behavioral Health & Social Service Providers
- Taxonomy code
- 1041C0700X
- License number
- LCSW-27205 (ID)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2007-06-27
- Last updated
- 2007-07-08
Practice location
310 N 2nd E, Suite 128
Rexburg, ID 83440-1600
(208) 356-5675