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General NPI Number Information
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NPI Number | 1932711165
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Entity Type | Individual
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Provider Name | SAMANTHA PAIGE AVERETT LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/19/2020
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 60 N BROADWAY
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City | BLACKFOOT
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State | ID
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Zip | 83221
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Country | US
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Telephone | 208-782-3434
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Fax | 208-782-1389
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Provider Business Mailing Address
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Address Line | PO BOX 1472
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City | BLACKFOOT
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State | ID
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Zip | 83221
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Country | US
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Telephone | 208-782-3434
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Fax | 208-782-1389
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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 |
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License Number State |
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