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1669117438
FRED DAVID DODGE
MERIDIAN, ID
NPI
1669117438
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: ID LCSW-40095)
Enumeration Date
2022-05-04
Last Update Date
2022-05-04
Business Address
FRED DAVID DODGE LCSW
2650 S EAGLE RD
MERIDIAN, ID 83642-6725
Phone number: 986-200-4290
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Mailing Address
FRED DAVID DODGE LCSW
2725 VIA VALDARNO
POCATELLO, ID 83201-5830
Phone number: 512-630-5140
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