Healthcare Provider Details

I. General information

NPI: 1114873262
Provider Name (Legal Business Name): LUCINDA ADJESIWOR PHD, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 2ND AVE N
TWIN FALLS ID
83301-6172
US

IV. Provider business mailing address

437 ORIOLE AVE
TWIN FALLS ID
83301-7766
US

V. Phone/Fax

Practice location:
  • Phone: 307-761-4179
  • Fax:
Mailing address:
  • Phone: 307-761-4179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: