Individual
SARAH LYNN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSW, LMSW
Contact information
Practice address
550 W SUNNYSIDE RD STE 1, IDAHO FALLS, ID 83402-4642
(208) 529-5777
(208) 529-5778
Mailing address
4383 W 49TH S, IDAHO FALLS, ID 83402-5726
(208) 520-6823
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW38260
ID
Other
Enumeration date
12/04/2019
Last updated
12/04/2019
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