ROBERTA GUSTAFSON

POCATELLO, ID
NPI1427413798
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy104100000X Social Worker
(Licence: ID  LMSW-33483)
Enumeration Date2015-12-30
Last Update Date2015-12-30
Business Address
-- ROBERTA GUSTAFSON LMSW
1501 BENCH RD
POCATELLO, ID 83201-2443
Phone number: 208-242-3044
Mailing Address
-- ROBERTA GUSTAFSON LMSW
344 N 15TH AVE APT 9A
POCATELLO, ID 83201-4042
Phone number: 208-957-1136
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