Provider Demographics
NPI:1356141030
Name:YAMEOGO, AMY LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:YAMEOGO
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2325 N BLUEBLOSSOM WAY
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-5078
Mailing Address - Country:US
Mailing Address - Phone:208-258-4762
Mailing Address - Fax:
Practice Address - Street 1:545 N BENJAMIN LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9623
Practice Address - Country:US
Practice Address - Phone:208-322-1026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2171058104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker