Individual
MRS. TIMMIE LYN JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1600 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401-4300
(208) 529-5279
Mailing address
603 E 1270 N, SHELLEY, ID 83274-4902
(208) 206-2864
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW-27752
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-32554
ID
Other
Enumeration date
04/06/2007
Last updated
03/08/2021
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