Healthcare Provider Details

I. General information

NPI: 1164758173
Provider Name (Legal Business Name): SHANNON LYNN SORINI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 W GEORGIA AVE STE 100
NAMPA ID
83686-2835
US

IV. Provider business mailing address

1123 12TH AVE RD
NAMPA ID
83686-5738
US

V. Phone/Fax

Practice location:
  • Phone: 208-409-7286
  • Fax: 208-465-1898
Mailing address:
  • Phone: 208-409-7286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-30968
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: