Individual
TINA MARIE BROADSWORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
14950 N COEUR DALENE ST, RATHDRUM, ID 83858-6484
(208) 687-0538
(208) 687-3185
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-4700
(208) 625-4701
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW37001
ID
1041C0700X
Clinical Social Worker
Primary
LMSW37001
ID
Other
Enumeration date
03/04/2020
Last updated
12/14/2020
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