Individual
LORI NICOLE EATON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3709 N LOCUST GROVE RD STE 100, MERIDIAN, ID 83646-6450
(208) 571-7100
(208) 493-4331
Mailing address
3709 N LOCUST GROVE RD STE 100, MERIDIAN, ID 83646-6450
(208) 571-7100
(208) 493-4331
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW 28083
ID
1041C0700X
Clinical Social Worker
Primary
LCSW- 31259
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1041C0700X
TAXONOMY
ID
01
—
20001460
PTAN
ID
05
—
806968300
—
ID
Enumeration date
01/21/2009
Last updated
10/17/2016
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