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General NPI Number Information
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NPI Number | 1235070509
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Entity Type | Individual
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Provider Name | DEIDRE COLVIN LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 2550 ADDISON AVE E
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City | TWIN FALLS
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State | ID
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Zip | 83301-6767
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Country | US
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Telephone | 208-814-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 3147 E CHASEWOOD DR
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City | AMMON
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State | ID
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Zip | 83406-4792
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Country | US
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Telephone | 208-716-4792
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Fax | 208-716-4792
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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 | 8921513
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License Number State | ID
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