Provider Demographics
NPI:1235523457
Name:SIDDOWAY, ROBERT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:SIDDOWAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 E ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-3527
Mailing Address - Country:US
Mailing Address - Phone:208-529-1854
Mailing Address - Fax:208-523-5974
Practice Address - Street 1:254 E ST
Practice Address - Street 2:SUITE B
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3527
Practice Address - Country:US
Practice Address - Phone:208-339-0816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-342431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical