Shandra Blacker, LMSW

NPI #1063892750 in Idaho Falls, Idaho

Provider Information

NPI Number: 1063892750
Entity Type: Individual
Name: Shandra Blacker, LMSW
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Social Worker - Clinical
Credential: LMSW
Enumeration Date: Jun 8, 2015
Last Updated: Jun 8, 2015

Practice Location

Address: 2275 W BROADWAY ST STE G
City: Idaho Falls
State: Idaho
ZIP Code: 83402-2902
Phone: (208) 524-7400

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X	Primary

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