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Provider Information for 1467706358


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JODI WARTHEN LCSW


Sex: Female

NPI: 1467706358
Last Updated: 2023-01-11
Certification Date: 2023-01-11

Details

NameValue
NPI1467706358
Enumeration Date2012-10-31
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 3037B E 3400 N
TWIN FALLS, ID 83301-0321
United States

Phone: 208-320-2252 | Fax:
 
Primary Practice Address 500 W FORT ST
BOISE, ID 83702-4501
United States

Phone: 208-422-1000 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 101YM0800X - Counselor - Mental HealthIDLMSW31409
Yes 101YM0800X - Counselor - Mental HealthIDlcsw34057