NPI 1194909952 · live from the CMS NPI Registry
Thayne Andersen, LCSW
Social Worker, Clinical in Fort Hall, ID. National Provider Identifier 1194909952, active.
NPI record
| NPI | 1194909952 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Social Worker, Clinical 1041C0700X |
| Practice location | 717 Mission Road, Fort Hall, ID 83203 |
| Practice phone | 208-237-5631 |
| Mailing address | Po Box 306, Fort Hall, ID 83203 |
| Enumerated | December 28, 2007 |
| Last updated | December 28, 2007 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Social Worker, Clinical primary | 1041C0700X | LCSW-27518 (ID) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.