Healthcare Provider Details

I. General information

NPI: 1588673586
Provider Name (Legal Business Name): LORA ANN OHLENSEHLEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 WASHINGTON ST N
TWIN FALLS ID
83301-4650
US

IV. Provider business mailing address

191 W 400 S
JEROME ID
83338-5949
US

V. Phone/Fax

Practice location:
  • Phone: 208-733-2872
  • Fax: 208-733-3261
Mailing address:
  • Phone: 208-324-5762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-24961
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: