NPI 1104436062 · live from the CMS NPI Registry
Ontaya Acedo, LMSW
Social Worker, Clinical in Pocatello, ID. National Provider Identifier 1104436062, active.
NPI record
| NPI | 1104436062 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Social Worker, Clinical 1041C0700X |
| Practice location | 151 N 3rd Ave Ste 330, Pocatello, ID 83201 |
| Practice phone | 208-242-3771 |
| Enumerated | August 5, 2020 |
| Last updated | March 31, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Social Worker | 104100000X | LMSW-39736 (ID) |
| Social Worker, Clinical primary | 1041C0700X | 8861355 (ID) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.