Individual
LINDA B LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3729 WOODKING DR STE 1, IDAHO FALLS, ID 83404-4720
(208) 356-4900
(208) 612-6118
Mailing address
PO BOX 18, SAINT ANTHONY, ID 83445-0018
(208) 356-4900
(208) 624-4112
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW-35024
ID
104100000X
Social Worker
LSW-33355
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-39592
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCSW-39592
IBOL
ID
Enumeration date
02/18/2014
Last updated
10/22/2024
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