Provider Demographics
NPI:1912480153
Name:LEWIS, NADINE M (LCSW)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:M
Other - Last Name:BUETTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 2186
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-0909
Mailing Address - Country:US
Mailing Address - Phone:419-615-7861
Mailing Address - Fax:
Practice Address - Street 1:1218 N DIVISION AVE STE 209
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-5054
Practice Address - Country:US
Practice Address - Phone:419-615-7861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-428161041C0700X
IDLMSW-365831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical