Healthcare Provider Details

I. General information

NPI: 1518292572
Provider Name (Legal Business Name): ANN O. YOUNG MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANN O. GUDMUNDSEN MSW

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 W. HAYS ST.
BOISE ID
83702
US

IV. Provider business mailing address

1408 W. HAYS ST.
BOISE ID
83702
US

V. Phone/Fax

Practice location:
  • Phone: 208-428-5730
  • Fax: 208-336-7125
Mailing address:
  • Phone: 208-428-5730
  • Fax: 208-336-7125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-26153
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: