Individual
CARRIE JANE LEELING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
204 OREGON ST, KELLOGG, ID 83837-5018
(208) 951-2767
Mailing address
PO BOX 331, SMELTERVILLE, ID 83868-0331
(208) 951-2767
(208) 225-4238
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW-36779
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-40791
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36779
STATE LICENSE
ID
Enumeration date
08/22/2017
Last updated
02/18/2025
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