Provider Demographics
NPI:1831960046
Name:GUZMAN, ALEJANDRA YANELY (LMSW)
Entity type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:YANELY
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ALEJANDRA
Other - Middle Name:YANELY
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:222 W 200 N
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-5234
Mailing Address - Country:US
Mailing Address - Phone:208-595-8866
Mailing Address - Fax:
Practice Address - Street 1:1102 EASTLAND DR N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-8941
Practice Address - Country:US
Practice Address - Phone:208-734-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-44485104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker