Healthcare Provider Details

I. General information

NPI: 1568786804
Provider Name (Legal Business Name): MRS. GEENA START
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 N MEADOWLARK WAY
COEUR D ALENE ID
83815-5041
US

IV. Provider business mailing address

7905 N MEADOWLARK WAY
COEUR D ALENE ID
83815-5041
US

V. Phone/Fax

Practice location:
  • Phone: 208-722-3116
  • Fax:
Mailing address:
  • Phone: 208-722-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLMSW 31923
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: