Healthcare Provider Details

I. General information

NPI: 1962323758
Provider Name (Legal Business Name): LISAUN ELIZABETH WHITTINGHAM LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3676 N HARBOR LN
BOISE ID
83703-6918
US

IV. Provider business mailing address

898 S PENCIL AVE
KUNA ID
83634-1977
US

V. Phone/Fax

Practice location:
  • Phone: 208-352-0081
  • Fax:
Mailing address:
  • Phone: 714-655-0247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2281815
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: