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General NPI Number Information
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NPI Number | 1144045758
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Entity Type | Individual
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Provider Name | BRANDY L ALLEN
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Gender | Female
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 1706 G ST
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City | LEWISTON
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State | ID
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Zip | 83501-2021
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Country | US
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Telephone | 208-751-0478
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Fax |
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Provider Business Mailing Address
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Address Line | 46987 HIGHWAY 95
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City | LAPWAI
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State | ID
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Zip | 83540-5146
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Country | US
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Telephone | 208-252-2692
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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 | 8921930
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License Number State | ID
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