Provider Demographics
NPI:1902307457
Name:SAPP, LAUREL JANE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:JANE
Last Name:SAPP
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 ANTELOPE WAY
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-1517
Mailing Address - Country:US
Mailing Address - Phone:423-364-1446
Mailing Address - Fax:
Practice Address - Street 1:314 BADIOLA ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4389
Practice Address - Country:US
Practice Address - Phone:208-454-8389
Practice Address - Fax:208-454-8404
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-373081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID37308OtherLMSW