| Bambi Lassen, Msw, Lcsw, Pllc | |
|
102 S Euclid Ave Ste 111 Sandpoint ID 83864-4916 | |
| (208) 263-4477 | |
| (208) 263-4478 |
| Full Name | Bambi Lassen, Msw, Lcsw, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 102 S Euclid Ave Ste 111, Sandpoint, Idaho |
| Authorized Official Name and Position | Bambi R. Lassen (CLINICIAN) |
| Authorized Official Contact | 2082905592 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bambi Lassen, Msw, Lcsw, Pllc Po Box 10 Dover ID 83825-0010 Ph: (208) 290-5592 | Bambi Lassen, Msw, Lcsw, Pllc 102 S Euclid Ave Ste 111 Sandpoint ID 83864-4916 Ph: (208) 263-4477 |
| NPI Number | 1154836427 |
|---|---|
| Provider Enumeration Date | 12/08/2017 |
| Last Update Date | 12/08/2017 |
| Medicare PECOS PAC ID | 6507125135 |
|---|---|
| Medicare Enrollment ID | O20180105000481 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154836427 | NPI | - | NPPES |
| 1063581429 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | 29490 (Idaho) | Primary |
| Provider Name | Bambi R Lassen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063581429 PECOS PAC ID: 2163674227 Enrollment ID: I20130124000352 |
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