Healthcare Provider Details

I. General information

NPI: 1528225281
Provider Name (Legal Business Name): CHARLOTTE ACKERMAN LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 ELK CREEK DR
IDAHO FALLS ID
83404-8322
US

IV. Provider business mailing address

1522 ELK CREEK DR
IDAHO FALLS ID
83404-8322
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-0920
  • Fax: 208-529-2564
Mailing address:
  • Phone: 208-522-0920
  • Fax: 208-529-2564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE ACKERMAN
Title or Position: OWNER
Credential: LCSW
Phone: 208-552-0920