Healthcare Provider Details

I. General information

NPI: 1407903149
Provider Name (Legal Business Name): GINNA MINERVINI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 N MONROE AVE
SANDPOINT ID
83864-2151
US

IV. Provider business mailing address

803 N MONROE AVE
SANDPOINT ID
83864-2151
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-8948
  • Fax: 208-265-1779
Mailing address:
  • Phone: 208-263-8948
  • Fax: 208-265-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-24438
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: