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NPI Code Detail

MEDICARE: AMY THOMPSON LSW

MEDICARE: AMY THOMPSON LSW
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
1104100000XSocial WorkerLSW-23961ID

General Provider Information

NPI Number : 1346481413
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY THOMPSON LSW
Provider Business Mailing Address
First Line : 740 WARM SPRINGS AVE
Second Line :
City : BOISE
State : ID
Zip : 83712-6420
Country : US
Telephone Number : 208-343-7797
Fax Number : 208-343-0064
Provider Business Practice Location Address
First Line : 740 WARM SPRINGS AVE
Second Line :
City : BOISE
State : ID
Zip : 83712-6420
Country : US
Telephone Number : 208-343-7797
Fax Number : 208-343-0064
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2009
Last Update Date : 03/18/2009

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