Lisa J Russom LSW

NPI 1003106691

Information of Lisa J Russom LSW

The NPI 1003106691 is an Individual type. NPI No 1003106691 belongs to Lisa J Russom. Lisa J Russom LSW specializes in Social Worker. She is practising at 1740 E 17th St, Idaho Falls, Idaho 83404. You can also contact him via phone number (208) 313-8355.

Practice address located

  • 1740 E 17th St
  • Idaho Falls, Idaho 83404
  • (208) 313-8355
  • (208) 313-8355

Mailling address located

  • 1740 E 17th St
  • Idaho Falls, Idaho 83404
  • (208) 313-8355
  • Not available
NPI No 1003106691
Primary Taxonomy
Specialty of the provider
PrimaryTaxonomy CodeClassificationLicense NumberLicense State
Yes104100000XSocial WorkerLSW-2573Idaho
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