Individual
DR. LAVONNA D PATTERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
111 E 16TH ST, IDAHO FALLS, ID 83404-5919
(208) 523-1130
(208) 529-6501
Mailing address
111 E 16TH ST, IDAHO FALLS, ID 83404-5919
(208) 523-1130
(208) 529-6501
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY202117
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002648300
—
ID
01
—
820428306
TRICARE
ID
01
—
N6168
BLUE CROSS
ID
Enumeration date
07/17/2006
Last updated
01/05/2017
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