Provider Demographics
NPI:1801438650
Name:RANDALL, CHERLA LADAWN (MS)
Entity type:Individual
Prefix:
First Name:CHERLA
Middle Name:LADAWN
Last Name:RANDALL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CHERLA
Other - Middle Name:LADAWN
Other - Last Name:KEATING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 3RD ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-3953
Mailing Address - Country:US
Mailing Address - Phone:208-524-5607
Mailing Address - Fax:208-524-0636
Practice Address - Street 1:540 3RD ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-3953
Practice Address - Country:US
Practice Address - Phone:208-524-5607
Practice Address - Fax:208-524-0636
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker