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General NPI Number Information
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NPI Number | 1386045433
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Entity Type | Individual
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Provider Name | SIDRAH S KHAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 10/01/2018
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Provider Practice Location Address
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Address Line | 242 N 8TH ST STE 200
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City | BOISE
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State | ID
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Zip | 83702
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Country | US
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Telephone | 208-447-9526
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Fax |
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Provider Business Mailing Address
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Address Line | 4714 N NYSTROM PL
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City | BOISE
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State | ID
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Zip | 83713-2522
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Country | US
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Telephone | 208-447-9526
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 72092550
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 092550
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License Number State | NY
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