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General NPI Number Information
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NPI Number | 1497347694
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Entity Type | Individual
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Provider Name | KRISTINA MARIE LODER LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 718 SHOSHONE ST E
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City | TWIN FALLS
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State | ID
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Zip | 83301-6111
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Country | US
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Telephone | 208-969-1112
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Fax | 208-696-0445
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Provider Business Mailing Address
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Address Line | 688 POLE LINE RD # 26
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City | TWIN FALLS
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State | ID
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Zip | 83301-3034
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Country | US
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Telephone | 208-969-1112
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Fax | 208-696-0445
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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 | LMSW-39984
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License Number State | ID
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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 | LCSW-43849
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License Number State | ID
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