Unknown Individual – Clinical Social Worker, NPI 1003881137

Unknown Individual is a healthcare provider. based in Lewiston, Idaho. specializing in Clinical Social Worker. They hold a License No. 29496 (ID). The NPI Number for Unknown Individual is 1003881137

Main info

Organization
Inactive
37 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1003881137
Phone
(208) 553-1603
Address
504 MAIN ST STE 472
Deactivation Date
3 February 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2085531603
Graduation Year
1989 (37 years ago)
PAC ID
3274692827
Professional Enrollment ID
I20100423000784
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 504 MAIN ST STE 472

    LEWISTON, ID 835011806

    Phone: (208) 553-1603

    Fax: (208) 746-7388

    Type: Mailing

  • Body Works NW, 504, Main Street, Lewiston, Nez Perce County, Idaho, 83501, United States

    SUITE 472

    LEWISTON, ID 835011803

    Phone: (208) 553-1603

    Fax: (208) 746-7388

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

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Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 83501)

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Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1003881137.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Clinical Social Worker. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Lewiston, Idaho?
If you are local to Lewiston, Idaho, Unknown Individual may be relevant to your search.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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