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General NPI Number Information
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NPI Number | 1265857999
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Entity Type | Individual
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Provider Name | MISS JUDITH LYNN CARROLL
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Gender | Female
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Dates
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Enumeration Date | 03/05/2014
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Last Update Date | 03/05/2014
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Provider Practice Location Address
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Address Line | 2428 N STOKESBERRY PL
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City | MERIDIAN
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State | ID
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Zip | 83646-5035
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Country | US
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Telephone | 208-939-3888
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Fax | 208-939-5599
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Provider Business Mailing Address
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Address Line | 2428 N STOKESBERRY PL
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City | MERIDIAN
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State | ID
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Zip | 83646-5035
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Country | US
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Telephone | 208-939-3888
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Fax | 208-939-5599
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-33648
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License Number State | ID
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