Provider Demographics
NPI:1376007781
Name:RAINSDON, RYANNE CHRISTINE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:RYANNE
Middle Name:CHRISTINE
Last Name:RAINSDON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 SUMMIT RUN TRL
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8246
Mailing Address - Country:US
Mailing Address - Phone:208-243-6541
Mailing Address - Fax:
Practice Address - Street 1:1970 E 17TH ST STE 208
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8048
Practice Address - Country:US
Practice Address - Phone:208-932-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW38315104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker