Provider Demographics
NPI:1790198513
Name:VAN KAMPEN-LEWIS, JOSEPHINE (LCSW)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:VAN KAMPEN-LEWIS
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 1:539 W 300 N
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-5463
Mailing Address - Country:US
Mailing Address - Phone:970-218-8281
Mailing Address - Fax:
Practice Address - Street 1:415 6TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2434
Practice Address - Country:US
Practice Address - Phone:208-799-5750
Practice Address - Fax:208-799-5758
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-388751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical