Provider Demographics
NPI:1528504206
Name:WALLING-GIFFORD, SARAH DEAUN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:DEAUN
Last Name:WALLING-GIFFORD
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 1:730 DRAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4696
Mailing Address - Country:US
Mailing Address - Phone:208-539-7470
Mailing Address - Fax:208-734-1404
Practice Address - Street 1:1102 EASTLAND DR N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-8941
Practice Address - Country:US
Practice Address - Phone:208-734-4200
Practice Address - Fax:208-734-1404
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLSW-35782104100000X
IDLMSW-36683104100000X
IDLCSW-394911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1528504206OtherPRIVATE INSURANCE