Provider Demographics
NPI:1457664294
Name:CARTWRIGHT, LAURA ELAINE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ELAINE
Last Name:CARTWRIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 N GOVERNMENT WAY SUITE 4
Mailing Address - Street 2:
Mailing Address - City:DALTON GARDENS
Mailing Address - State:ID
Mailing Address - Zip Code:83815
Mailing Address - Country:US
Mailing Address - Phone:208-620-7195
Mailing Address - Fax:208-625-2070
Practice Address - Street 1:5920 N GOVERNMENT WAY SUITE 4
Practice Address - Street 2:
Practice Address - City:DALTON GARDENS
Practice Address - State:ID
Practice Address - Zip Code:83815
Practice Address - Country:US
Practice Address - Phone:208-620-7195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
308221041C0700X
IDLMSW-267351041C0700X
IDLCSW 308221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2071711Medicaid