Provider Demographics
NPI:1124807631
Name:VATERLAUS, LEANN W (LMSW)
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:W
Last Name:VATERLAUS
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 1:6126 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-2741
Mailing Address - Country:US
Mailing Address - Phone:208-391-5941
Mailing Address - Fax:208-593-4807
Practice Address - Street 1:6126 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-2741
Practice Address - Country:US
Practice Address - Phone:208-391-5941
Practice Address - Fax:208-593-4807
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-43080104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker