Provider Demographics
NPI:1821489105
Name:TEIGEN, CORINNE (LMSW)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:TEIGEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-3956
Mailing Address - Country:US
Mailing Address - Phone:208-429-3854
Mailing Address - Fax:208-336-7290
Practice Address - Street 1:5678 N PINERY CANYON AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5809
Practice Address - Country:US
Practice Address - Phone:208-360-7857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-4281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical