KENRIC GLENN GORDON

CHUBBUCK, ID
NPI1114540804
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy104100000X Social Worker
(Licence: ID  LMSW-39661)
Enumeration Date2020-05-28
Last Update Date2020-05-28
Business Address
KENRIC GLENN GORDON LMSW
210 W BURNSIDE AVE STE A
CHUBBUCK, ID 83202-4916
Phone number: 208-238-9000
Mailing Address
KENRIC GLENN GORDON LMSW
210 W BURNSIDE AVE STE A
CHUBBUCK, ID 83202-4916
Phone number: 208-238-9000
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