Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | LMSW-34846 | ID |
Y | 1041C0700X | Clinical Social Worker | LCSW-39386 | ID |
NPI | 1003448713 |
---|---|
Provider Name | Suzanne Albert |
First Address | Caldwell, ID 83607-6703 |
Second Address | Nampa, ID 83686-6100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2020 |
Last Update Date | 28/02/2020 |