Healthcare Provider Details

I. General information

NPI: 1821062811
Provider Name (Legal Business Name): RHONDA ALLENGER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RHONDA ALLENGER LSW

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 CAMBRIDGE CT
MOSCOW ID
83843-9663
US

IV. Provider business mailing address

PO BOX 8391
MOSCOW ID
83843-0891
US

V. Phone/Fax

Practice location:
  • Phone: 509-850-0408
  • Fax:
Mailing address:
  • Phone: 509-850-0408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLW00005252
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-39748
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: