MEDICARE: VALERIE SIMONSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1366676884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE SIMONSON

Provider Business Mailing Address
First Line	:	2128 SAINT CLAIR RD # 8
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-6355
Country	:	US
Telephone Number	:	208-339-0378
Fax Number	:

Provider Business Practice Location Address
First Line	:	2128 SAINT CLAIR RD # 8
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-6355
Country	:	US
Telephone Number	:	208-339-0378
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	05/12/2009

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Directions to “ VALERIE SIMONSON ” Practice Location

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