Healthcare Provider Details

I. General information

NPI: 1275444283
Provider Name (Legal Business Name): LEONEL CHRISTINE ANDERSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

IV. Provider business mailing address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-4117
  • Fax:
Mailing address:
  • Phone: 208-625-4000
  • Fax: 208-625-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8851590
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: