Provider Demographics
NPI:1831461623
Name:OSEN, MELISSA DAWN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DAWN
Last Name:OSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:DAWN
Other - Last Name:ROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:459 LOCUST ST N SUITE 108
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301
Mailing Address - Country:US
Mailing Address - Phone:208-539-2226
Mailing Address - Fax:208-481-8489
Practice Address - Street 1:459 LOCUST ST N SUITE 108
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301
Practice Address - Country:US
Practice Address - Phone:208-539-2226
Practice Address - Fax:208-481-8489
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-31726104100000X
IDLCSW-317261041C0700X
IDLCSW-371211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker