Healthcare Provider Details

I. General information

NPI: 1770332967
Provider Name (Legal Business Name): STEPHANIE RIMER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2024
Last Update Date: 05/18/2024
Certification Date: 05/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 W CENTER ST STE 218
POCATELLO ID
83204-3236
US

IV. Provider business mailing address

357 W CENTER ST STE 218
POCATELLO ID
83204-3236
US

V. Phone/Fax

Practice location:
  • Phone: 801-655-5450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-45134
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: