NPI age
19 years
Enumerated 2006-07-14
Across 2000 active social worker providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 12261220 | CAQH PIN |
| 01 (ID) | LCSW-24551 | PROFESSIONAL LICENSE |
| 05 (ID) | 807237800 |
Part of a multi-provider practice. 4 other active providers share this practice address in NPPES.
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