Kenric Glenn Gordon, LMSW

NPI #1114540804 in Chubbuck, Idaho

Provider Information

NPI Number: 1114540804
Entity Type: Individual
Name: Kenric Glenn Gordon, LMSW
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Social Worker
Credential: LMSW
Enumeration Date: May 28, 2020
Last Updated: May 28, 2020

Practice Location

Address: 210 W BURNSIDE AVE STE A
City: Chubbuck
State: Idaho
ZIP Code: 83202-4916
Phone: (208) 238-9000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker	104100000X	Primary

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