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General NPI Number Information
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NPI Number | 1093594921
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Entity Type | Individual
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Provider Name | SUSANNE WIMBERLEY LMSW
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Gender |
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Dates
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Enumeration Date | 09/28/2023
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 1033 BALDY MOUNTAIN RD
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City | SANDPOINT
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State | ID
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Zip | 83864-9202
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Country | US
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Telephone | 208-920-5151
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Fax |
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Provider Business Mailing Address
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Address Line | 810 SIXTH AVE
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City | SANDPOINT
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State | ID
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Zip | 83864-5396
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Country | US
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Telephone |
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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-38827
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License Number State | ID
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