Individual
MS. KRISTINE ANNETTE LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
111 N WASHINGTON ST STE 13, MOSCOW, ID 83843-2884
(208) 596-4129
Mailing address
417 E VEATCH ST, MOSCOW, ID 83843-3570
(208) 596-4129
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
I-04976
NM
1041C0700X
Clinical Social Worker
Primary
LCSW35858
ID
Other
Enumeration date
07/23/2007
Last updated
08/10/2021
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