Provider Demographics
NPI:1821395732
Name:P'POOL, VALERIE ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANN
Last Name:P'POOL
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 453
Mailing Address - Street 2:
Mailing Address - City:UCON
Mailing Address - State:ID
Mailing Address - Zip Code:83454-0453
Mailing Address - Country:US
Mailing Address - Phone:208-569-4450
Mailing Address - Fax:
Practice Address - Street 1:2267 TETON PLZ
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6486
Practice Address - Country:US
Practice Address - Phone:208-524-4953
Practice Address - Fax:208-524-7335
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-12
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-34441104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511515Medicaid