LISA J RUSSOM

IDAHO FALLS, ID
NPI1003106691
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy104100000X Social Worker
(Licence: ID  LSW-2573)
Enumeration Date2011-04-15
Last Update Date2011-04-15
Business Address
-- LISA J RUSSOM LSW
1740 E 17TH ST
IDAHO FALLS, ID 83404-6375
Phone number: 208-313-8355
Mailing Address
-- LISA J RUSSOM LSW
1740 E 17TH ST
IDAHO FALLS, ID 83404-6375
Phone number: 208-313-8355
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