Provider Demographics
NPI:1891950754
Name:PENDER, BRIGETTE D (LCSW)
Entity Type:Individual
Prefix:
First Name:BRIGETTE
Middle Name:D
Last Name:PENDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRIGETTE
Other - Middle Name:D
Other - Last Name:HAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:13403 N GOVERNMENT WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8906
Mailing Address - Country:US
Mailing Address - Phone:208-719-1030
Mailing Address - Fax:
Practice Address - Street 1:13403 N GOVERNMENT WAY STE 102
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8906
Practice Address - Country:US
Practice Address - Phone:208-719-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-316191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical