Provider Demographics
NPI:1518414606
Name:WEATHERS, EMMY LAURIE (MSW, LMSW)
Entity Type:Individual
Prefix:
First Name:EMMY
Middle Name:LAURIE
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:EMMY
Other - Middle Name:LAURIE
Other - Last Name:OLMSTEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:413 N ALLUMBAUGH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9212
Mailing Address - Country:US
Mailing Address - Phone:208-323-1125
Mailing Address - Fax:208-323-9604
Practice Address - Street 1:413 N ALLUMBAUGH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9212
Practice Address - Country:US
Practice Address - Phone:208-323-1125
Practice Address - Fax:208-323-9604
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-32291104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker