Kevin Ryan Anderson
Social Worker in Ammon, ID. Individual provider (NPI-1).
NPI number1649816182
StatusActive
Last updated in NPPESNov 19, 2019
Details
- NPI
- 1649816182
- Entity type
- Individual (NPI-1)
- Name
- Mr. Kevin Ryan Anderson
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 19, 2019
- Last updated
- Nov 19, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 104100000X | Social Worker | – | – | Yes |
Practice location
2705 E 17th StAmmon, ID 83406-6601
Phone 208-346-7500
Mailing address
2705 E 17th StAmmon, ID 83406-6601
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