Provider Demographics
NPI:1093813446
Name:TIMONEN, WAYNE BINGHAM (LMSW)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:BINGHAM
Last Name:TIMONEN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7905 N MEADOWLARK WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-5041
Mailing Address - Country:US
Mailing Address - Phone:208-762-3979
Mailing Address - Fax:208-762-4419
Practice Address - Street 1:7905 N MEADOWLARK WAY
Practice Address - Street 2:SUITE C
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-5041
Practice Address - Country:US
Practice Address - Phone:208-762-3979
Practice Address - Fax:208-762-4419
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-245031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical