Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | LMSW-26553 | ID |
NPI | 1003826405 |
---|---|
Provider Name | Mr. Joshua Charles Bode |
First Address | Boise, ID 83706-4267 |
Second Address | Boise, ID 83702-4501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |