Lisa J Russom, LSW
NPI #1003106691 in Idaho Falls, Idaho
Provider Information
- NPI Number
- 1003106691
- Entity Type
- Individual
- Name
- Lisa J Russom, LSW
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Social Worker
- Credential
- LSW
- Enumeration Date
- Apr 15, 2011
- Last Updated
- Apr 15, 2011
Practice Location
- Address
- 1740 E 17TH ST
- City
- Idaho Falls
- State
- Idaho
- ZIP Code
- 83404-6375
- Phone
- (208) 313-8355
Specialties & Taxonomy Codes
| Specialty |
|---|
| Social Worker |
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