Provider Demographics
NPI:1952645426
Name:RICE, LYNN ROSELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:ROSELLE
Last Name:RICE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LYNN
Other - Middle Name:ROSELLE
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:118 9TH AVE N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6352
Mailing Address - Country:US
Mailing Address - Phone:208-731-5260
Mailing Address - Fax:208-644-3213
Practice Address - Street 1:118 9TH AVE N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6352
Practice Address - Country:US
Practice Address - Phone:208-731-5260
Practice Address - Fax:208-644-3213
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-34284104100000X
IDLCSW-368191041C0700X, 104100000X
IDOTA-67224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant