Healthcare Provider Details

I. General information

NPI: 1831539980
Provider Name (Legal Business Name): AMY IRENE OHS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E MAIN ST
SAINT ANTHONY ID
83445-1546
US

IV. Provider business mailing address

PO BOX 18
SAINT ANTHONY ID
83445-0018
US

V. Phone/Fax

Practice location:
  • Phone: 208-356-4900
  • Fax: 208-624-4030
Mailing address:
  • Phone: 208-356-4900
  • Fax: 208-624-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-29950
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: