Provider Demographics
NPI:1558734483
Name:RIDDLE, COURTNEY (LMSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:RIDDLE
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 1:212 N 1ST AVE
Mailing Address - Street 2:#103
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1436
Mailing Address - Country:US
Mailing Address - Phone:208-265-8195
Mailing Address - Fax:
Practice Address - Street 1:608 S DIVISION AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1749
Practice Address - Country:US
Practice Address - Phone:208-265-5049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-35268104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker