Healthcare Provider Details

I. General information

NPI: 1215587332
Provider Name (Legal Business Name): ANGELLA JOY CATLIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 571
IONA ID
83427-0571
US

IV. Provider business mailing address

5211 E NELSON DR
IONA ID
83427-4102
US

V. Phone/Fax

Practice location:
  • Phone: 208-557-3227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-42631
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13922-889-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: