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1730923699
MALLORY ANTONETTA WILSON
TWIN FALLS, ID
NPI
1730923699
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: ID 13044)
Enumeration Date
2024-06-24
Last Update Date
2024-06-24
Business Address
MALLORY ANTONETTA WILSON SUDA
630 ADDISON AVE W STE 1000
TWIN FALLS, ID 83301-5853
Phone number: 208-736-5048
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Mailing Address
MALLORY ANTONETTA WILSON SUDA
630 ADDISON AVE W STE 1000
TWIN FALLS, ID 83301-5853
Phone number: 208-736-5048
Copy
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