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General NPI Number Information
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NPI Number | 1184280968
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Entity Type | Individual
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Provider Name | LINDSEY M BASNAW
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Gender | Female
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Dates
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Enumeration Date | 05/16/2019
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 822 KOOTENAI CUTOFF RD
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City | PONDERAY
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State | ID
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Zip | 83852-9720
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Country | US
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Telephone | 208-304-8711
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Fax |
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Provider Business Mailing Address
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Address Line | 822 KOOTENAI CUTOFF RD
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City | PONDERAY
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State | ID
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Zip | 83852-9720
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Country | US
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Telephone | 208-304-8711
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Fax | 509-684-5286
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | SA60711545
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8671832
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License Number State | ID
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