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General NPI Number Information
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NPI Number | 1821489105
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Entity Type | Individual
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Provider Name | CORINNE TEIGEN LMSW
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Gender | Female
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 5678 N PINERY CANYON AVE
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City | MERIDIAN
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State | ID
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Zip | 83646-5809
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Country | US
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Telephone | 208-360-7857
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Fax |
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Provider Business Mailing Address
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Address Line | 1819 W STATE ST
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City | BOISE
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State | ID
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Zip | 83702-3956
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Country | US
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Telephone | 208-429-3854
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Fax | 208-336-7290
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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 | LMSW-428
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License Number State | ID
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