Provider Demographics
NPI:1679516009
Name:WATSON, VICKI ANNE (MSW)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:ANNE
Last Name:WATSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E CENTER ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5737
Mailing Address - Country:US
Mailing Address - Phone:208-233-9205
Mailing Address - Fax:208-234-3660
Practice Address - Street 1:850 E CENTER ST
Practice Address - Street 2:SUITE F
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5737
Practice Address - Country:US
Practice Address - Phone:208-233-9205
Practice Address - Fax:208-234-3660
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 1911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical