Provider Demographics
NPI:1538529888
Name:AMMANN, L STEPHEN (LMSW)
Entity type:Individual
Prefix:
First Name:L STEPHEN
Middle Name:
Last Name:AMMANN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10332 DUCK LN
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-9174
Mailing Address - Country:US
Mailing Address - Phone:360-969-2707
Mailing Address - Fax:208-908-0580
Practice Address - Street 1:2500 W KOOTENAI ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2408
Practice Address - Country:US
Practice Address - Phone:208-908-0500
Practice Address - Fax:208-908-0580
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW355041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical