Provider Demographics
NPI:1306209101
Name:PRICE, LINDA I (LSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:I
Last Name:PRICE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 WALKER DR
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1657
Mailing Address - Country:US
Mailing Address - Phone:208-705-5437
Mailing Address - Fax:208-359-4785
Practice Address - Street 1:333 WALKER DR
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1657
Practice Address - Country:US
Practice Address - Phone:208-705-5437
Practice Address - Fax:208-359-4785
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLSW-1301104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker