MR. SHAWN ROBERT ISRAELSEN LCSW NPI 1629679048

NPI Information

NPI: 1629679048
Provider Name: MR. SHAWN ROBERT ISRAELSEN, LCSW
Classification: Counselor - 101YP2500X
Entity Type: Individual

Specialization: Professional

PECOS Registration: Yes

Address:
2265 W BROADWAY ST
IDAHO FALLS, ID
ZIP 83402
Phone: (208) 524-7400
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MR. Shawn Robert Israelsen, LCSW is a professional counselor in Idaho Falls, ID with 7 years of experience. MR. Shawn Robert Israelsen, LCSW NPI is 1629679048. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2265 W BROADWAY ST
IDAHO FALLS, ID
ZIP 83402-996
Phone: (208) 524-7400
Fax: (208) 534-8004

The NPI 1629679048 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 11/3/2020 and was last updated on 10/18/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	104100000X	Social Worker		LMSW-18733	ARIZONA	No
2	104100000X	Social Worker		LMSW-40331	IDAHO	No
3	1041C0700X	Social Worker	Clinical	8722060-3502	UTAH	No
4	1041C0700X	Social Worker	Clinical	8722060-3502CSW	UTAH	No
5	101YP2500X	Counselor	Professional	LCSW-44276	IDAHO	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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