Provider Demographics
NPI:1376861138
Name:FALCK, SUSAN F (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:FALCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6843 MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-8552
Mailing Address - Country:US
Mailing Address - Phone:208-946-9572
Mailing Address - Fax:208-267-9020
Practice Address - Street 1:7583 N. MAIN STREET HWY 95
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-1837
Practice Address - Country:US
Practice Address - Phone:208-267-1801
Practice Address - Fax:208-267-9020
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW12961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical