Provider Demographics
NPI:1366631160
Name:WATSON, LAURA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:WATSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3770 E BLACK CANYON HWY
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-9503
Mailing Address - Country:US
Mailing Address - Phone:208-365-3437
Mailing Address - Fax:
Practice Address - Street 1:3770 E BLACK CANYON HWY
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-9503
Practice Address - Country:US
Practice Address - Phone:208-365-3437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-293621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical