Healthcare Provider Details

I. General information

NPI: 1447207162
Provider Name (Legal Business Name): ALEXIA M DEETZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: ALEXIA M JOSLIN DEETZ LCSW

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 SHOSHONE ST E
TWIN FALLS ID
83301-6338
US

IV. Provider business mailing address

1002 SHOSHONE ST E
TWIN FALLS ID
83301-6338
US

V. Phone/Fax

Practice location:
  • Phone: 208-734-7714
  • Fax: 208-735-5323
Mailing address:
  • Phone: 208-734-7714
  • Fax: 208-735-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-25103
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: