Lisa J Russom
Social Worker
1740 E 17th St
Idaho Falls
, Idaho 83404-6375
Lisa J Russom
Social Worker
1740 E 17th St
Idaho Falls
, Idaho 83404-6375
(208) 313-8355
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About
Features
Specialties
- Social Worker
Languages spoken
- English
Location
First Address
- Lisa J Russom
- 1740 E 17th St
- Idaho Falls, ID
- Zip : 83404-6375
- Phone : (208) 313-8355
Second Address
- Lisa J Russom
- 1740 E 17th St
- Idaho Falls, ID
- Zip : 83404-6375
- Phone : (208) 313-8355
Reviews
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 104100000X | Social Worker | LSW-2573 | ID |
National Provider Identifier
| NPI | 1003106691 |
|---|---|
| Provider Name | Lisa J Russom |
| First Address | Idaho Falls, ID 83404-6375 |
| Second Address | Idaho Falls, ID 83404-6375 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 15/04/2011 |
| Last Update Date | 15/04/2011 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.