Provider Demographics
NPI:1942625173
Name:NEIBAUR, AMANDA KAY (LMSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:NEIBAUR
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 1:6855 W FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8046
Mailing Address - Country:US
Mailing Address - Phone:208-323-8888
Mailing Address - Fax:208-323-8889
Practice Address - Street 1:9474 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8101
Practice Address - Country:US
Practice Address - Phone:208-378-8046
Practice Address - Fax:208-908-0094
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-31593104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker