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General NPI Number Information
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NPI Number | 1083149793
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Entity Type | Individual
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Provider Name | SHANYL ROBINSON
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Gender | Female
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 150 SHOUP AVE STE 17
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3653
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Country | US
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Telephone | 208-528-5704
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Fax |
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Provider Business Mailing Address
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Address Line | 217 E RICH LN
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City | BLACKFOOT
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State | ID
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Zip | 83221-5901
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Country | US
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Telephone | 208-680-2608
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-35217
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License Number State | ID
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