Individual
SANDI DE EATINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
3422 S 15TH E, IDAHO FALLS, ID 83404-8262
(208) 552-1222
(208) 552-3377
Mailing address
3422 S 15TH E, IDAHO FALLS, ID 83404-8262
(208) 552-1222
(208) 552-3377
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW-1502
ID
1041C0700X
Clinical Social Worker
Primary
LCSW27315
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805384500
—
ID
01
—
82052319683404B005
TRICARE BILLING NUMBER
ID
01
—
L5931
IDAHO BLUE CROSS PIN
ID
Enumeration date
10/18/2006
Last updated
06/02/2008
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