Provider Demographics
NPI:1356761332
Name:WRIGHT, CARRIE ANN (MA)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ANN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 JENNIE LEE DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6159
Mailing Address - Country:US
Mailing Address - Phone:208-520-7074
Mailing Address - Fax:208-970-6188
Practice Address - Street 1:1908 JENNIE LEE DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6159
Practice Address - Country:US
Practice Address - Phone:208-520-7074
Practice Address - Fax:208-970-6188
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW389581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID843320113Medicaid