Individual
ANDREA BOWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 743-2511
Mailing address
415 6TH ST, LEWISTON, ID 83501-2431
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-37990
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LMSW-37990
IDAHO BUREAU OF OCCUPATIONAL LICENSES
ID
Enumeration date
06/21/2019
Last updated
06/21/2019
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