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General NPI Number Information
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NPI Number | 1376861138
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Entity Type | Individual
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Provider Name | SUSAN F. FALCK LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 10/03/2016
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Provider Practice Location Address
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Address Line | 7583 N. MAIN STREET HWY 95
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City | BONNERS FERRY
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State | ID
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Zip | 83805-1837
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Country | US
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Telephone | 208-267-1801
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Fax | 208-267-9020
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Provider Business Mailing Address
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Address Line | 6843 MAIN ST SUITE D
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City | BONNERS FERRY
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State | ID
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Zip | 83805-8552
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Country | US
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Telephone | 208-946-9572
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Fax | 208-267-9020
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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 | LCSW1296
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License Number State | ID
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