Provider Demographics
NPI:1588673586
Name:OHLENSEHLEN, LORA ANN (LCSW)
Entity Type:Individual
Prefix:PROF
First Name:LORA
Middle Name:ANN
Last Name:OHLENSEHLEN
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 1:191 W 400 S
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-5949
Mailing Address - Country:US
Mailing Address - Phone:208-324-5762
Mailing Address - Fax:
Practice Address - Street 1:426 WASHINGTON ST N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4650
Practice Address - Country:US
Practice Address - Phone:208-733-2872
Practice Address - Fax:208-733-3261
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-249611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical