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General NPI Number Information
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NPI Number | 1871642728
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Entity Type | Individual
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Provider Name | LAURA PARKS LSW
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Gender | Female
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 586 1ST ST
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City | IDAHO FALLS
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State | ID
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Zip | 83401-3963
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Country | US
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Telephone | 208-529-2920
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Fax |
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Provider Business Mailing Address
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Address Line | 340 MOONLITE DR APT 4
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City | IDAHO FALLS
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State | ID
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Zip | 83402-2343
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Country | US
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Telephone | 208-403-6456
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW-27649
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License Number State | ID
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