DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: MR. SHAWN ROBERT ISRAELSEN LCSW

MEDICARE: MR. SHAWN ROBERT ISRAELSEN 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
1104100000XSocial WorkerLMSW-18733AZ
2104100000XSocial WorkerLMSW-40331ID
31041C0700XClinical Social Worker8722060-3502UT
41041C0700XClinical Social Worker8722060-3502CSWUT
5101YP2500XProfessional CounselorLCSW-44276ID

General Provider Information

NPI Number : 1629679048
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SHAWN ROBERT ISRAELSEN LCSW
Provider Business Mailing Address
First Line : 2275 W. BROADWAY ST #G
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83402-2902
Country : US
Telephone Number : 208-524-7400
Fax Number : 208-524-8004
Provider Business Practice Location Address
First Line : 2265 W BROADWAY ST
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83402-2996
Country : US
Telephone Number : 208-524-7400
Fax Number : 208-534-8004
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2020
Last Update Date : 10/18/2023

Similar Medicare Providers

1447337068 — STEPHANIE GANSCHOW PHARMD
Practice Location Address:
2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106
Practice Phone: 605-373-0100
Practice Fax:
1750239638 — ERIKA MICHELLE DOHERTY LPC
Practice Location Address:
2265 W BROADWAY ST
IDAHO FALLS, ID
83402-2996
Practice Phone: 208-542-7400
Practice Fax: 208-524-8004
1013683408 — LIZA PAIGE HANSEN LCSW
Practice Location Address:
2265 W BROADWAY ST
IDAHO FALLS, ID
83402-2996
Practice Phone: 208-524-7400
Practice Fax: 208-524-8004
1497603856 — TYSEN DEREK DAVIS
Practice Location Address:
2265 W BROADWAY ST
IDAHO FALLS, ID
83402-2996
Practice Phone: 208-524-7400
Practice Fax: 208-524-8004
1710609987 — MARIA GOMEZ LCSW
Practice Location Address:
2265 W BROADWAY ST
IDAHO FALLS, ID
83402-2996
Practice Phone: 208-524-7400
Practice Fax: 208-524-8004
1477766905 — TUELLER COUNSELING INC
Practice Location Address:
2265 W BROADWAY ST
IDAHO FALLS, ID
83402-2996
Practice Phone: 208-524-7400
Practice Fax: 208-524-8004

Directions to “ MR. SHAWN ROBERT ISRAELSEN LCSW” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.