Provider Demographics
NPI:1851184055
Name:UNRUH, LYNDA
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:UNRUH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 W ALLIANCE ST
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-0139
Mailing Address - Country:US
Mailing Address - Phone:253-579-4342
Mailing Address - Fax:
Practice Address - Street 1:6201 W ALLIANCE ST
Practice Address - Street 2:
Practice Address - City:RATHDRUM
Practice Address - State:ID
Practice Address - Zip Code:83858-0139
Practice Address - Country:US
Practice Address - Phone:253-579-4342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCFH-10180253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency