Most Relevant Information
Provider Data
| NPI Number: | 1003593914 |
| Provider Name: | MARY KAY GORDON-BRUNNER |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | LCSW-33403 |
Most Important Dates
| Enumeration Date: | 07/03/2023 |
| Last Updated: | 08/10/2023 |
Provider Practice Location
314 BADIOLA ST
CALDWELL
ID
836054389
Practice Location Phone/Fax
| Phone: | 7025894871 |
| Fax: |
Provider Mailing Location
PO BOX 264
MIDDLETON
ID
836440264
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |