Provider Demographics
NPI:1942016100
Name:FRYER, ADA KATHERINE (LMSW)
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:KATHERINE
Last Name:FRYER
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 1:437 LEE RD
Mailing Address - Street 2:
Mailing Address - City:HARPSTER
Mailing Address - State:ID
Mailing Address - Zip Code:83552-5061
Mailing Address - Country:US
Mailing Address - Phone:208-251-8931
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 367
Practice Address - Street 2:
Practice Address - City:LAPWAI
Practice Address - State:ID
Practice Address - Zip Code:83540-0367
Practice Address - Country:US
Practice Address - Phone:208-843-2271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2661074104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker