Provider Demographics
NPI:1912588799
Name:HUPPERT, LISA NOEL (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:NOEL
Last Name:HUPPERT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1842
Mailing Address - Country:US
Mailing Address - Phone:208-750-1000
Mailing Address - Fax:
Practice Address - Street 1:1020 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1842
Practice Address - Country:US
Practice Address - Phone:208-750-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID40031104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker