Provider Demographics
NPI:1114786084
Name:PRICE, ANNA KATRINA (BSW)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:KATRINA
Last Name:PRICE
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 AMERICAN LEGION BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-3166
Mailing Address - Country:US
Mailing Address - Phone:208-830-9052
Mailing Address - Fax:208-277-1342
Practice Address - Street 1:1815 AMERICAN LEGION BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-3151
Practice Address - Country:US
Practice Address - Phone:208-590-1262
Practice Address - Fax:208-277-1342
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker