Individual
THERESA LEA NIEDERKRUGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
573 N MINERAL WELLS AVE, MERIDIAN, ID 83642-7609
(208) 871-8468
Mailing address
573 N MINERAL WELLS AVE, MERIDIAN, ID 83642-7609
(208) 871-8468
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
29200
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806552901
—
ID
05
—
807382800
—
ID
01
—
830415084 83651 A001
TRICARE PROVIDER NUMBER
ID
Enumeration date
10/21/2006
Last updated
07/03/2025
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