Provider Demographics
NPI:1063713501
Name:SAL DANA, KRISTIEN ANN (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTIEN
Middle Name:ANN
Last Name:SAL DANA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 F ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1930
Mailing Address - Country:US
Mailing Address - Phone:208-553-9060
Mailing Address - Fax:
Practice Address - Street 1:1118 F ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1930
Practice Address - Country:US
Practice Address - Phone:208-553-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-28541104100000X
IDLCSW-324391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker