Provider Demographics
NPI:1518292572
Name:YOUNG, ANN O (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:O
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:O
Other - Last Name:GUDMUNDSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1408 W. HAYS ST.
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702
Mailing Address - Country:US
Mailing Address - Phone:208-428-5730
Mailing Address - Fax:208-336-7125
Practice Address - Street 1:1408 W. HAYS ST.
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-428-5730
Practice Address - Fax:208-336-7125
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-261531041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical