Provider Demographics
NPI:1477171643
Name:PADILLA, ANNE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:PADILLA
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 1:509 S SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1555
Mailing Address - Country:US
Mailing Address - Phone:208-272-0593
Mailing Address - Fax:
Practice Address - Street 1:8100 W EMERALD ST STE 150
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9057
Practice Address - Country:US
Practice Address - Phone:208-908-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID26495104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLMSW-26495OtherIDAHON BUREAU OF OCCUPATIONAL LICENSES