Provider Demographics
NPI:1184280968
Name:BASNAW, LINDSEY M
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:M
Last Name:BASNAW
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 KOOTENAI CUTOFF RD
Mailing Address - Street 2:
Mailing Address - City:PONDERAY
Mailing Address - State:ID
Mailing Address - Zip Code:83852-9720
Mailing Address - Country:US
Mailing Address - Phone:208-304-8711
Mailing Address - Fax:509-684-5286
Practice Address - Street 1:822 KOOTENAI CUTOFF RD
Practice Address - Street 2:
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852-9720
Practice Address - Country:US
Practice Address - Phone:208-304-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASA60711545101Y00000X
ID86718321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor