Provider Demographics
NPI:1629443916
Name:RAPP, DELISA KAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DELISA
Middle Name:KAY
Last Name:RAPP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 S EAGLE RD
Mailing Address - Street 2:MOUNTAIN STATES TUMOR INSTITUTE
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6351
Mailing Address - Country:US
Mailing Address - Phone:208-706-1404
Mailing Address - Fax:208-706-1442
Practice Address - Street 1:520 S EAGLE RD
Practice Address - Street 2:MOUNTAIN STATES TUMOR INSTITUTE
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6351
Practice Address - Country:US
Practice Address - Phone:208-706-1404
Practice Address - Fax:208-706-1442
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-319051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical