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NPI Code Detail

MEDICARE: ALISON NICOLE RIDER LCSW

MEDICARE: ALISON NICOLE RIDER LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCSW-45390ID

General Provider Information

NPI Number : 1053989947
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALISON NICOLE RIDER LCSW
Provider Business Mailing Address
First Line : 346 W LOVEJOY ST APT 7
Second Line :
City : POCATELLO
State : ID
Zip : 83204-3462
Country : US
Telephone Number : 208-251-4776
Fax Number :
Provider Business Practice Location Address
First Line : 151 N 3RD AVE STE 330
Second Line :
City : POCATELLO
State : ID
Zip : 83201-6369
Country : US
Telephone Number : 208-242-3771
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2021
Last Update Date : 03/27/2025

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Directions to “ ALISON NICOLE RIDER LCSW” Practice Location

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