Individual
RIKKI M DAVLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4604 N PENNGROVE WAY STE 110, MERIDIAN, ID 83646-7442
(085) 056-9512
(888) 793-0268
Mailing address
PO BOX 849, NAMPA, ID 83653-0849
(208) 505-6951
(888) 793-0268
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW32149
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20001411
MEDICARE PTAN
ID
Enumeration date
06/18/2012
Last updated
02/14/2024
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