Unknown Individual – Clinical Social Worker, NPI 1083707277

Unknown Individual is a healthcare provider. based in Emmett, Idaho. specializing in Clinical Social Worker. They hold a License No. LCSW24210 (ID). The NPI Number for Unknown Individual is 1083707277

Main info

Organization
Inactive
40 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1083707277
Phone
(208) 365-5445
Address
2007 S PLAZA
Deactivation Date
23 April 2026

Doctor Profile

Medical School Name
UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE
Secondary Phone
2083655445
Graduation Year
1986 (40 years ago)
PAC ID
3577500248
Group Practice PAC ID
0749469468
Professional Enrollment ID
I20050413001291
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

Provider Addresses for Unknown Individual

  • 2007 S PLAZA

    SUITE #1

    EMMETT, ID 83617

    Phone: (208) 365-5445

    Fax: (208) 365-6226

    Mailing address matches the actual address.

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.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

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

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

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

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 83617)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0749469468View full group profile
NameSpecialtyState
-ID
Mental Health CounselorID
Clinical Social WorkerID
Clinical Social WorkerID
P S Y C H I A T R YID
-ID

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1083707277.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's primary classification?
Clinical Social Worker is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Emmett, Idaho as a primary anchor for Unknown Individual unless the record lists multiple sites.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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