| Nicmh | |
|
1717 Ontario St Sandpoint ID 83864-9329 | |
| (208) 265-6798 | |
| (208) 263-8160 |
| Full Name | Nicmh |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1717 Ontario St, Sandpoint, Idaho |
| Authorized Official Name and Position | Kim Bendickson (OFFICE MANAGER) |
| Authorized Official Contact | 2082656798 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicmh 1717 W. Ontario St Sandpoint ID 83864-8268 Ph: (208) 265-6798 | Nicmh 1717 Ontario St Sandpoint ID 83864-9329 Ph: (208) 265-6798 |
| NPI Number | 1083773378 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 05/13/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083773378 | NPI | - | NPPES |
| 806106400 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCSW-25493 (Idaho) | Primary |
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