Provider Demographics
NPI:1831509280
Name:SONTAG, MARY-ANN (PHD LCSW)
Entity type:Individual
Prefix:DR
First Name:MARY-ANN
Middle Name:
Last Name:SONTAG
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 N BRYSON RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5038
Mailing Address - Country:US
Mailing Address - Phone:406-369-5293
Mailing Address - Fax:
Practice Address - Street 1:2201 N BRYSON RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5038
Practice Address - Country:US
Practice Address - Phone:406-369-5293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical