Graduated: 2018
NPI: 1932674553
Practice Locations (2)
COMMUNITY COUNCIL OF IDAHO, INC.
1491 PKWY DR
BLACKFOOT, ID 832211667
2087820500
COMMUNITY COUNCIL OF IDAHO, INC.
2100 ALAN ST
IDAHO FALLS, ID 834045801
2085287655
Source: CMS National Downloadable File, September 2026.