Provider Demographics
NPI:1962762534
Name:POOLE, LORI JO (LCSW)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:JO
Last Name:POOLE
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 1:7615 MCMULLEN ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-0836
Mailing Address - Country:US
Mailing Address - Phone:208-861-0798
Mailing Address - Fax:208-514-2718
Practice Address - Street 1:818 NW 15TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3724
Practice Address - Country:US
Practice Address - Phone:208-888-5566
Practice Address - Fax:208-888-5578
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-28421104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker