Individual
ANGIE A. SHANTIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1118 F ST, LEWISTON, ID 83501-1930
(208) 799-4440
(208) 799-5171
Mailing address
1118 F STREET, LEWISTON, ID 83501
(208) 799-4440
(208) 799-5171
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-30605
ID
Other
Enumeration date
04/01/2016
Last updated
04/01/2016
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