NPI 1003106691

Lisa J Russom, LSW

Practitioner Social Worker Idaho Falls, ID

Practice location

Address: 1740 E 17th St, Idaho Falls, ID 83404-6375
Phone: (208) 313-8355

Registered specialties

Social Worker Primary

Behavioral Health & Social Service Providers Taxonomy 104100000X Licence LSW-2573 (ID)

Other Social Worker providers in Idaho →

Registry record

NPI: 1003106691
Entity type: Individual
Sex (as registered): Female
NPI issued: 15 Apr 2011
Record last updated: 15 Apr 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.