Individual
AMANDA NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
2235 E 25TH ST, SUITE 160, IDAHO FALLS, ID 83404-7519
(208) 522-9812
(208) 522-9859
Mailing address
649 N 550 E, FIRTH, ID 83236-1123
(208) 681-5067
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW29364
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806647900
—
ID
Enumeration date
05/18/2010
Last updated
05/18/2010
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