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General NPI Number Information
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NPI Number | 1003277039
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Entity Type | Individual
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Provider Name | ANNA LOUISE LAWRENCE LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/18/2016
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | 207 LARKSPUR ST
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City | PONDERAY
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State | ID
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Zip | 83852-5011
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Country | US
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Telephone | 208-255-3314
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Fax | 208-263-4198
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Provider Business Mailing Address
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Address Line | 8120 N AINSWORTH DR
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City | HAYDEN
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State | ID
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Zip | 83835-7987
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Country | US
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Telephone | 208-277-5114
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Fax | 208-263-4198
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW26759
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License Number State | ID
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