Provider Demographics
NPI:1568760635
Name:MANWARING, ALICE DAWN (LCSW)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:DAWN
Last Name:MANWARING
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:PO BOX 18
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:ID
Mailing Address - Zip Code:83445-0018
Mailing Address - Country:US
Mailing Address - Phone:208-356-4900
Mailing Address - Fax:208-624-4030
Practice Address - Street 1:72 S 1ST E STE 103
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1965
Practice Address - Country:US
Practice Address - Phone:208-356-4900
Practice Address - Fax:208-372-1023
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-380591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical