Individual
MS. SUZANNE IANNACCONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4090 W STATE ST STE 221, BOISE, ID 83703
(208) 505-8813
Mailing address
4090 W STATE ST STE 221, BOISE, ID 83703-4450
(208) 505-8813
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC05594800
NJ
1041C0700X
Clinical Social Worker
LCSW-37811
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44SC05594800
NJ LCSW LICENSE
NJ
Enumeration date
08/22/2014
Last updated
09/21/2018
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